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Form # CMS 179
Form Title TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL
Revision Date 07/01/1992
O.M.B. # 0938-0193
O.M.B. Expiration Date 10/31/2010
CMS Manual N/A
Special Instructions N/A

 


 
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CMS 179 (656 KB)
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Last Modified Date : 11/26/2008
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