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Form 2067, Case Information
Purpose. To request and share case information not available through data inquiry. Form 2067 is used by Health and Human Services Commission staff. Procedure.
Feb 14, 2022 Filing Period Opens: Friday, January 7, 2022. Filing Period Closes: Monday, February 14, 2022. Applications and all other required documents
Outputs: Flame Relay: 2 Form C Contacts (DPDT). Self-Check Relay: 1 Form C Contact (SPDT). Self-Check Contact Ratings: Max switching power - 60 W 125Vac.
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