Claim for Reimbursement for Emergency Medical Care

OMB 3240-0030

OMB 3240-0030

Latest Forms, Documents, and Supporting Material

Document Name
Form SSS FORM 166 Claim for Reimbursement for Emergency Medical Care Form and Instruction
SSS FORM 166 SUPPORTING STATEMENT.pdf Supporting Statement B
SSS FORM 166.pdf Supporting Statement A
Claim for Reimbursement for Emergency Medical Care Form and Instruction

All Historical Document Collections

200807-3240-018 Withdrawn	Extension without change of a currently approved collection	2008-07-24
200506-3240-002 Approved with change	Extension without change of a currently approved collection	2005-06-07
200205-3240-004 Approved without change	Extension without change of a currently approved collection	2002-05-08
199902-3240-006 Approved without change	Extension without change of a currently approved collection	1999-02-11
199512-3240-002 Approved without change	Extension without change of a currently approved collection	1995-12-13
199208-3240-003 Approved without change	Extension without change of a currently approved collection	1992-08-27
198911-3240-004 Approved without change	Extension without change of a currently approved collection	1989-11-07
198701-3240-004 Approved without change	New collection (Request for a new OMB Control Number)	1987-01-28

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