OMB control number
Claim for Reimbursement for Emergency Medical Care
OMB 3240-0030 ยท SSS.
OMB 3240-0030
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 200807-3240-018 | Extension without change of a currently approved collection | 2008-07-24 | Withdrawn | |
| 200506-3240-002 | Extension without change of a currently approved collection | 2005-06-07 | Approved with change | |
| 200205-3240-004 | Extension without change of a currently approved collection | 2002-05-08 | Approved without change | |
| 199902-3240-006 | Extension without change of a currently approved collection | 1999-02-11 | Approved without change | |
| 199512-3240-002 | Extension without change of a currently approved collection | 1995-12-13 | Approved without change | |
| 199208-3240-003 | Extension without change of a currently approved collection | 1992-08-27 | Approved without change | |
| 198911-3240-004 | Extension without change of a currently approved collection | 1989-11-07 | Approved without change | |
| 198701-3240-004 | New collection (Request for a new OMB Control Number) | 1987-01-28 | Approved without change |