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Supporting Statement
Supporting Statement.doc
Health Insurance Claim Form, HCFA 1450
OMB: 0720-0013
OMB.report
DOD/DODOASHA
OMB 0720-0013
ICR 200811-0720-001
Supporting Statement
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0720-0013 can be found here:
2017-05-12 - Reinstatement with change of a previously approved collection
2012-01-31 - Extension without change of a currently approved collection
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