OMB control number
Health Insurance Medical History Questionnaire
OMB 0990-0072 · HHS/HHSDM.
OMB 0990-0072
Latest Forms, Documents, and Supporting Material
Document Name |
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HEALTH INSURANCE MEDICAL HISTORY QUESTIONNAIRE All Historical Document Collections
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Approved without change |
New collection (Request for a new OMB Control Number) | 1981-10-02 |