Implementation of the Military Health System Modified Payment and Waiver Program

OMB 0720-0083

Latest Forms, Documents, and Supporting Material

Document Name
Form DD3201-1 Request for Medical Debt Waiver, Military Health System Modified Payment and Waiver Program Form and Instruction
Form DD3201 Request for Medical Debt Discount, Military Health System Modified Payment and Waiver Program Form
0720-0083_SSA_1.30.2026.docx Supporting Statement A
Disapproval Memo script.docx Supplementary Document
SSNJ_DDFormx3201_07.13.2023.pdf Supplementary Document
Request for Medical Debt Waiver, Military Health System Modified Payment and Waiver Program Form and Instruction
Request for Medical Debt Discount, Military Health System Modified Payment and Waiver Program Form