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Program Operations Manual System (POMS)
Effective Dates: 07/19/2000 - Present
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HI 00820.901
Exhibit 1: CMS-1763 (Request for Termination of Premium Hospital and/or Supplementary Medical Insurance)
To view the form, go to CMS-1763
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600820901
HI 00820.901 - Exhibit 1: CMS-1763 (Request for Termination of Premium Hospital and/or Supplementary Medical Insurance) - 07/19/2000
Batch run:
07/10/2019
Rev:
07/19/2000