OMB control number
Physician's Statement Regarding Patient's Capability To Manage Payments
OMB 3220-0103 · RRB.
OMB 3220-0103
Latest Forms, Documents, and Supporting Material
PHYSICIAN'S STATEMENT REGARDING PATIENT'S CAPABILITY TO MANAGE PAYMENTS All Historical Document Collections
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Approved with change |
No material or nonsubstantive change to a currently approved collection | 1981-02-28 | |
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Approved without change |
Revision of a currently approved collection | 1980-02-19 | |
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Approved without change |
Revision of a currently approved collection | 1979-08-28 | |
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Approved without change |
Reinstatement without change of a previously approved collection | 1979-07-31 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 1974-05-15 |