OMB control number

Application For Hospital Insurance

OMB 0960-0091 · SSA.

OMB 0960-0091

Latest Forms, Documents, and Supporting Material

Document Name
APPLICATION FOR HOSPITAL INSURANCE Form

All Historical Document Collections

197809-0960-001 Approved without change	Revision of a currently approved collection	1978-09-21
197601-0960-002 Approved without change	Extension without change of a currently approved collection	1976-01-09