Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs

MAPS Appeals Screenshots - Revised Version

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version

OMB: 0960-0695

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Appeals Input Screen

Appeals Other Information Screen

Appeals Other Information Screen Continued

Appeals Results Screen


File Typeapplication/pdf
Author889123
File Modified2017-05-03
File Created2017-05-03

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