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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Application and Renewal for Health Benefits
Modified
1904940
1008180
0
Form
10-10EZ
Application for Health Care Benefits
Form
10-10EZR
HEALTH BENEFITS RENEWAL FORM
Total burden requested under this ICR:
1904940
1008180
0
To view an IC, click on IC Title
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The .gov means it's official.
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