Request For Termination Of Supplementary Medical Insurance

REQUEST FOR TERMINATION OF SUPPLEMENTARY MEDICAL INSURANCE

OMB: 3220-0098

IC ID: 157631

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Information Collection (IC) Details

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REQUEST FOR TERMINATION OF SUPPLEMENTARY MEDICAL INSURANCE
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form G-718 No No


    

150 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 150 0 -5 -395 0 550
Annual IC Time Burden (Hours) 13 0 -1 -78 0 92
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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