Appeal of Determination for Help with Medicare Prescription Drug Plan Costs

ICR 202312-0960-004

OMB: 0960-0695

Federal Form Document

Forms and Documents

Document Name	Status
Addendum - 0695 (Final).docx Supplementary Document	2023-12-29
Supporting Statement - 0695 (Final).docx Supporting Statement A	2023-12-29

IC Document Collections

IC ID	Document Title	Status
9749	Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - Paper Version Instruction	Modified
227171	Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version Other-Intranet Screens	Modified