OMB control number
Health Insurance Claim Form
OMB 0704-0325 ยท DOD/DODDEP.
OMB 0704-0325
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 HEALTH INSURANCE CLAIM FORM |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 199105-0704-001 | New collection (Request for a new OMB Control Number) | 1991-05-13 | Approved without change |