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Imm5564  Form

Imm5564 Form

Use a imm5564 template to make your document workflow more streamlined.

Covers all the information that you have provided on this application for IFHP coverage. PROTECTED WHEN COMPLETED - B PAGE 1 OF 2 APPLICATION FOR INTERIM FEDERAL HEALTH PROGRAM COVERAGE Complete this form only if you are eligible for Interim Federal Health Program IFHP coverage. If you are applying to extend your existing IFHP coverage make sure to apply six 6 weeks before your current eligibility period expires. Make sure that you read and understand the accompanying instructions before you...
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