used for other purposes where authorized by Title 38, U.S.C., and the Privacy Act of 1974 (5 U.S.C. 552a) or where required by other statute. VA FORM MAR 2004 (R) (retain this portion for your records) CHAMPVA Potential Liability Claim Appendix 10-7959d相关...
VAFORM MAR2004(R) 36.Icertifythattheaboveinformationandattachmentsarecorrect tothebestofmyknowledgeandbelief.(Signanddateonright.)If signedbyapersonotherthanpatient,completethefollowing. OMBNumber:2900-0219 EstimatedBurden:7minutes ExpirationDate:3/31/2007 CHAMPVAPotentialLiabilityClaim DenverCO80206-9023...