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Separately Billing Doctors Form
Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB: 0935-0118
IC ID: 191104
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202406-0935-002
IC 191104
( )
Documents and Forms
Document Name
Document Type
Form 59
Separately Billing Doctors Form
Form and Instruction
59 Separately Billing Doctors Event Form
Attachment 59 -- Separately Billing Doctors Event Form.docx
Form and Instruction
Information Collection (IC) Details
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