OMB control number
COBRA Continuation Coverage: Premium Assistance
OMB 1210-0167 · DOL/EBSA.
OMB 1210-0167
Latest Forms, Documents, and Supporting Material
Document Name |
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Supporting Statement A |
Supplementary Document |
1210-0NEW- SS_COBRA Premium Assistance 4.6.21.docx
COBRA Notices All Historical Document Collections
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Approved with change |
New collection (Request for a new OMB Control Number) | 2021-04-06 |