Request For Medicare Payment By Mmhd Facility

OMB 0938-0145

Latest Forms, Documents, and Supporting Material

Document Name
REQUEST FOR MEDICARE PAYMENT BY MMHD FACILITY Form

All Historical Document Collections

198203-0938-003 Approved without change	Extension without change of a currently approved collection	1982-03-19
198101-0938-004 Approved without change	New collection (Request for a new OMB Control Number)	1981-01-08