OMB control number
Health Insurance Medical History Questionnaire
OMB 0990-0072 ยท HHS/HHSDM.
OMB 0990-0072
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 HEALTH INSURANCE MEDICAL HISTORY QUESTIONNAIRE |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 198110-0990-001 | New collection (Request for a new OMB Control Number) | 1981-10-02 | Approved without change |