Shown below are the details for the item you selected from the list.
| Form # |
CMS 1561A |
| Form Title |
HEALTH INSURANCE BENEFIT AGREEMENT-RURAL HEALTH CLINIC |
| Revision Date |
04/01/2002 |
| O.M.B. # |
0938-0832 |
| O.M.B. Expiration Date |
12/31/2010 |
| CMS Manual |
N/A |
| Special Instructions |
N/A |
| | | Downloads |
CMS 1561A
| | Related Links Inside CMS |
There are no Related Links Inside CMS
| | Related Links Outside CMS |  |
There are no Related Links Outside CMS
|
|
Last Modified Date : 08/18/2008
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