PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
REQUEST FOR TERMINATION OF HOSPITAL &/OR SUPPLEMENTARY MEDICAL INSURANCE
Migrated
25000
12500
0
Form
SSA-1763
Total burden requested under this ICR:
25000
12500
0
To view an IC, click on IC Title
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The .gov means it's official.
The site is secure.
