Form DD3201-1 Request for Medical Debt Waiver, Military Health System

Implementation of the Military Health System Modified Payment and Waiver Program

DD3201-1 DRAFT 20260130

Request for Medical Debt Waiver, Military Health System Modified Payment and Waiver Program

OMB: 0720-0083

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File Type	application/pdf
File Title	DD Form 3201-1, "REQUEST FOR MEDICAL DEBT WAIVER ..MILITARY HEALTH SYSTEM MODIFIED PAYMENT AND WAIVER PROGRAM"
File Modified	2026-01-30
File Created	2023-10-20