Get Federation History Request Ebahr Reporting Form

The Federation History Request Ebahr Reporting Form is essential for obtaining your Examination and Board Action History Report. This guide provides clear, step-by-step instructions to help you easily fill out the form online.

Follow the steps to complete the Ebahr reporting form online.

1. Click ‘Get Form’ button to obtain and open the form in your preferred editor.
2. Begin by filling out Section I, Personal Information. Provide your last name, first name, alternate name, address, date of birth, phone number, email, and relevant identification numbers.
3. In Section II, Examination History, check all relevant examinations you have taken, documenting how many times you sat for each and the dates of your most recent attempts.
4. Proceed to Section III, Calculation of Required Payment. Indicate the number of EBAHRs being requested, remember that each $50 fee covers up to two recipients. Include the express delivery fee if necessary.
5. Move on to Section IV, Authorization. Select the examination types you wish included in your report and provide the complete name and address for each recipient.
6. Add your signature and the date to authorize the release of your examination information as outlined in this section, understanding the implications of this authorization.
7. Ensure that Section IV, Part C is notarized completely according to the checklist provided. This includes obtaining the notary's stamp, signature, commission expiration date, and the date of notarization.
8. Once your form is completed and notarized, you can save changes, download, print, or share the form as needed.

Complete your Ebahr reporting form online today to ensure timely processing of your report.