Information Collection

10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers

IC 213638 under ICR 202005-2900-019 · OMB 2900-0823.

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Information Collection (IC) Details

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IC Title:	10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers	Agency IC Tracking Number:	2900-0823

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 1730(d) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 122,274	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	122,274	122,274
Annual IC Time Burden (Hours)	10,190	10,190
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.