Form 28 State Licensing Board Attestation

State Licensing Board Attestation Form and Instruction

Non-visible Questions
Label

PDF Name
(step)

Location

Response
Input
Item

Visibility Trigger

Why are you
removing this
profession?

State
Licensing
Board
Attestation
(1)

Under Profession Drop List
Name

If the user unchecks
the checkbox in a
row, then the field
is displayed.

Additional
Professions

State
Licensing
Board
Attestation
(1)

Below Add a
Text Entry
Profession if
your board
regulates a
profession that is
not listed”

If the user adds a
profession from the
modal that requires
a description then
the field is
displayed.

+Description
(optional)

State
Licensing
Board
Attestation
(1)

Beside
Additional
Profession

Text Entry If the user adds a
profession from the
modal, an
additional optional
field is displayed.

Why are you
unable to
attest?

State
Licensing
Board
Attestation
(2)

Below the Yes
No button in a
table row

Text Entry When the user
selects No for “Can
you attest” for a in a
row, then the field
is displayed.

Why not?

State
Licensing
Board
Attestation
(2)

Below the Yes
and No radio
buttons after
Querying
Confidentiality

Text Entry The field is
displayed if the user
selects the No radio
button

Other

State Changes
Label

PDF Name

Item Type

Trigger

OMB Number:
0915-0126
Expiration
Date:
mm/dd/yyyy

State Licensing
Board Attestation

Modal

When the user selects the link the modal is displayed
with the public burden statement content.

Select an
Occupation or
Field of
Licensure

State Licensing
Board Attestation
(1)

Modal

When the user selects the link “+ Add a profession”
the modal to select a profession is displayed and
focus is set on the Search text entry. The user can
enter text in the Search text box to find a specific
profession or select a profession from the list
without searching. The modal is hidden once the
user selects a profession from the list. The user's
selection adds the selected profession to the list
under “Additional Profession(s)”