Va Form Fl 10-341b - Trainee Qualification And Credentials Verification Letter
Download a blank fillable Va Form Fl 10-341b - Trainee Qualification And Credentials Verification Letter in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Va Form Fl 10-341b - Trainee Qualification And Credentials Verification Letter with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2DEPARTMENT OF VETERANS AFFAIRS
In Reply Refer To:
OMB Number 2900-0205
Estimated burden 5 min. per trainee listed
Dear
1
1. I certify that the information identified below has been verified for the trainees who are listed below
and who are scheduled to receive all or part of their clinical training at a Department of Veterans
Affairs (VA) facility.
SSN (last 4
Discipline of Study
Degree Level or Post
Trainee Name(s)
numbers)
or Specialty
Graduate Year (PGY)
2. In addition, I certify that these trainees:
(a) Are enrolled in the designated training program and have met the criteria for the
specified level of training;
(b) Have satisfactory health to perform the duties of the clinical training program;
(c) Have had tuberculin testing as required by the Center for Disease Control (CDC) or
VA standards;
(d) Have had hepatitis B vaccination or have signed declination waivers;
(e) Have had primary source verification of educational credentials as required by the
admission criteria of the training program;
(f) Have had primary source verification of current license(s), registration(s) including DEA
registration, or certification(s) through the state licensing board(s) and/or national and state
certification bodies as required by the training program;
1
NOTE: Any trainee who does not meet all of the criteria or upon whom all primary source
verification has not been accomplished should be processed on a separate Trainees Qualifications
and Credentials Verification Letter (TQCVL). For these trainees, deficiencies or discrepancies
should be stated explicitly and an explanation provided.
FL 10-341b
Page 1 of 2
MAR 2009
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal