Form CMS-1561 Health Insurance Benefits Agreement
Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491 (CMS-1561)
CMS-1561 form.tif
Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491
OMB: 0938-0832
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0832 can be found here:
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