Form AA-6 (01-12) AA-6 (01-12) Employee Application for Medicare

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0082 can be found here:

• 2022-06-08 - No material or nonsubstantive change to a currently approved collection
• 2021-06-30 - Revision of a currently approved collection