Document
DD Form 2569, "THIRD PARTY COLLECTION PROGRAM/MEDICAL SERVICES ACCOUNT/ OTHER HEALTH INSURANCE"
ICR 202205-0720-001 · OMB 0720-0055 · Object 121710100.
This document may belong to an older filing. More recent activity for OMB 0720-0055:
Document Viewer [pdf]
Status: No verified local artifact is currently available. The document remains flagged for repair and upstream re-check.
Queue: Repair is queued and waiting for the next worker pass. (priority 20 · next 2026-08-04 11:37:40)
Missing: pdf
No local or Spaces-backed artifact is available yet for this document.
Loading document viewer…
Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | DD Form 2569, "THIRD PARTY COLLECTION PROGRAM/MEDICAL SERVICES ACCOUNT/ OTHER HEALTH INSURANCE" |
| File Modified | 2022-06-16 |
| File Created | 2022-06-01 |
| Conversion State | failed_conversion |