CMS Forms

Form #
CMS 29
Form Title
REQUEST TO ESTABLISH ELIGIBILITY TO PARTICIPATE IN HI FOR AGED/DISABLED TO PROVIDE RURAL HEALTH CLINIC SERVICES
Revision Date
05/01/1978
O.M.B. #
0938-0074
O.M.B. Expiration Date
02/29/2012
CMS Manual
N/A
Special Instructions
N/A