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Form G-740S (07-01) G-740S (07-01) Patient's Request for Medicare Payment
Request for Medicare Payment
G-740S (07-01)
Request for Medicare Payment
OMB: 3220-0131
OMB.report
RRB
OMB 3220-0131
ICR 200908-3220-001
IC 44217
Form G-740S (07-01) G-740S (07-01) Patient's Request for Medicare Payment
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0131 can be found here:
2022-09-21 - Extension without change of a currently approved collection
2019-04-30 - Revision of a currently approved collection
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File Modified
2006-06-27
File Created
2006-06-27
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