Report of Medicaid State Office on Beneficiary's Buy-In Status

Report of Medicaid State Office on Beneficiary's Buy-In Status

OMB: 3220-0185

IC ID: 33999

Documents and Forms

Document Name Document Type
Form RL-380-F (05-18) Report of Medicaid State Office on Beneficiary's Buy-In Status Form
RL-380-F (05-18) Report of Medical State Office on Beneficiary's Buy-In Status Form RL-380-F (05-18).pdf Form
RL-380-F (Proposed) Report of Medical Beneficiary's Buy-In Status Form RL-380-F (XX-XX).pdf Form
CMS-1957 (04-18).pdf Report of State Buy-In Problem IC Document