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Health Insurance Medical History Questionnaire
OMB 0990-0072
OMB.report
HHS/HHSDM
OMB 0990-0072
OMB 0990-0072
Latest Forms, Documents, and Supporting Material
Document
Name
HEALTH INSURANCE MEDICAL HISTORY QUESTIONNAIRE
Form
All Historical Document Collections
198110-0990-001
Approved without change
New collection (Request for a new OMB Control Number)
1981-10-02
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