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Summary of Benefits and Coverage Completed Example
ICR 201908-1210-001 · OMB 1210-0147 · Object 94039001.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Summary of Benefits and Coverage Completed Example |
| Subject | Example of completed summary of benefits and coverage |
| Author | CMS |
| File Created | 2021-01-15 |
| Conversion State | partial |