VA Form 20-2850 is better known as an Application for Physicians but also includes, dentists, podiatrists, optometrists, and chiropractors. This form is used to verify the credentials and qualifications of applying medical professional and collects personal information such as their license information, along with their full name, address, social security number, and citizenship information. The Department of Veterans Affairs will use all of this collected information to ensure that the individual is qualified to work in the Veterans Health Administration. It is important to complete the document in its entirety, furnishing all required spaces to ensure that the application is processed as quickly as possible by the Department.
This form is used by the United States Department of Veterans Affairs. The VA Form 20-2850 is known as an Application for Physicians, Dentists, Podiatrists, Optometrists, and Chiropractors (OMB No. 2900-0205). The form is used to verify the qualifications of one of these parties to determine if they can be a member of the Veterans Health Administration.
This form will require detailed information about the medical professional who is applying for recognition. They will need to list their personal and contact information, including full name, address, citizenship information, and social security number. In the following sections, the applicant will need to detail their licensing information. The Department of Veterans Affairs will verify this information to ensure the professional is qualified to join the Veterans Health Administration.
This form is commonly used by physicians, dentists, podiatrists, optometrists, and chiropractors who would like to become members of the Veterans Health Administration.
A VA Form 10-2850 contains the following sections:
To complete a VA Form 10-2850, you will need to provide the following information:
This form is similar to the following VA Forms:
If you need additional space to answer a question, attach a separate sheet of paper and refer to the number of the item being answered by number.
The U.S. Department of Veterans Affairs is conducting this information collection to determine your qualifications for employment. It has authority to do so under Title 38, United States Code, Chapters 73 and 74. OMB Number 2900-0205.
The information provided on the form may be released without your prior consent to another U.S. government, state, or local agency, to the National Practitioner Data Bank which is administered by the Department of Health and Human Services, to State licensing boards, and other appropriate organizations or agencies.
Disclosure of your social security information is necessary to obtain the employment benefits that you are applying for. The VA is authorized to ask you for your SSN under Executive Order 9397, dated November 22, 1943.
