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Medical Assessment Form - Reporting Time for Medical Specialist, General
Medical Assessment Form and Dental Assessment Form
OMB: 0970-0466
IC ID: 261414
OMB.report
HHS/ACF
OMB 0970-0466
ICR 202308-0970-002
IC 261414
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0466 can be found here:
2023-12-06 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Medical Assessment Form - Reporting Time for Medical Specialist, General
Form
1 Medical Assessment Form
ORR Medical Assessment Form.docx
Form
Attachment B_Medical Assessment Form Instructional Letter for Medical Providers.docx
Attachment B - Medical Assessment Form Instructional Letter for Medical Providers
IC Document
Information Collection (IC) Details
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