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
| Document | Type |
|---|---|
 PHYSICIAN'S STATEMENT REGARDING PATIENT'S CAPABILITY TO MANAGE PAYMENTS |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 198102-3220-045 | No material or nonsubstantive change to a currently approved collection | 1981-02-28 | Approved with change | |
| 198002-3220-002 | Revision of a currently approved collection | 1980-02-19 | Approved without change | |
| 197908-3220-010 | Revision of a currently approved collection | 1979-08-28 | Approved without change | |
| 197907-3220-015 | Reinstatement without change of a previously approved collection | 1979-07-31 | Approved without change | |
| 197405-3220-004 | New collection (Request for a new OMB Control Number) | 1974-05-15 | Approved without change |