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Request For National Provider Identification Number
REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER
OMB: 2900-0702
IC ID: 179986
OMB.report
VA
OMB 2900-0702
ICR 200712-2900-010
IC 179986
( )
Documents and Forms
Document Name
Document Type
Form 10-0449A
REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER
Form
10-0449A REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER
10-0449A-fill.pdf
http:www.va.gov/vaforms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER
Agency IC Tracking Number:
2900-0702
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
45 CFR 162
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
10-0449A
REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER
10-0449A-fill.pdf
http:www.va.gov/vaforms
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
10
0
0
0
0
10
Annual IC Cost Burden (Dollars)
0
0
0
-3
0
3
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
