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Respondents should be aware that notwithstanding any other provision of law no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION* RETURN COMPLETED FORM TO REQUESTING MILITARY TREATMENT FACILITY. PRIVACY ACT STATEMENT AUTHORITY Title 10 USC Sections 1079b Procedures for charging fees for care provided to civilian retention and ...

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