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Supporting Statement 1240-0055 - EC_MN2 nonsub 4.22.2024 - EC clean
Supporting Statement 1240-0055 - EC_MN2 nonsub 4.22.2024 - EC clean.docx
Authorization Request Forms/Certification/Letter of Medical Necessity
OMB: 1240-0055
OMB.report
DOL/OWCP
OMB 1240-0055
ICR 202404-1240-005
Supporting Statement 1240-0055 - EC_MN2 nonsub 4.22.2024 - EC clean
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0055 can be found here:
2024-05-30 - Revision of a currently approved collection
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