OMB control number

Evidence of Coverage under An Employer Group Health Plan

OMB 3220-0189 · RRB.

OMB 3220-0189

Latest Forms, Documents, and Supporting Material

Document Name
Evidence of Coverage under An Employer Group Health Plan Form

All Historical Document Collections

199709-3220-002 Approved without change	Revision of a currently approved collection	1997-09-24
199407-3220-003 Approved without change	New collection (Request for a new OMB Control Number)	1994-07-26