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Attachment 2 - Sur Certification of Status for Death Benefit - Alternative
Countermeasures Injury Compensation Program (CICP)
10162023 - (18) Survivor Package - Attachment 2 - Certification of Status for Death Benefit - Alternative Calculation - CLEAN.do
Benefits Package and Supporting Documentation
OMB: 0915-0334
OMB.report
HHS/HSA
OMB 0915-0334
ICR 202401-0915-002
IC 208418
Attachment 2 - Sur Certification of Status for Death Benefit - Alternative
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