SSA-788 (current)
SSA-788(current).pdf
Statement of Care and Responsibility for Beneficiary
SSA-788 (current)
OMB: 0960-0109
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0109 can be found here:
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| File Type | application/pdf |
| File Modified | 2015-03-19 |
| File Created | 2015-03-09 |