Document
Form Approved
ICR 201208-0955-007 · OMB 0955-0007 · Object 34505301.
Document Viewer [doc]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-07-01 05:01:44)
Missing: html
Download: Source copy (doc)
Loading document viewer…
Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Form Approved |
| Author | DHHS |
| Last Modified By | DHHS |
| File Modified | 2010-11-18 |
| File Created | 2010-11-18 |
| Conversion State | partial |