Privacy Act System of Records-FEC

Privacy Act Systems-FECA.docx

Authorization Request Forms/Certification/Letter of Medical Necessity

Privacy Act System of Records-FEC

OMB: 1240-0055

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0055 can be found here:

2024-05-30 - Revision of a currently approved collection

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