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Office Based Providers Form
Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB: 0935-0118
IC ID: 191103
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202406-0935-002
IC 191103
( )
Documents and Forms
Document Name
Document Type
Form 58
Office Based Providers Form
Form and Instruction
58 Office Based Provider Event Form
Attachment 58 -- Office Based Provider Event Form.docx
Form and Instruction
Information Collection (IC) Details
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