Get the IHS Form 912-1, Request for Restriction(s) - hhs

Description of OMB
IHS-912-1 (4/09) DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED: OMB NO. 0917-0030 Expiration Date: 1/31/2013 See OMB Statement below. Indian Health Service REQUEST FOR RESTRICTION(S) I understand
Fill & Sign Online, Print, Email, Fax, or Download
Get Form
Get, Create, Make and Sign thumbprint
  • Get Form
  • eSign
  • Fax
  • Email
  • Add Annotation
  • Share
Fill EF: Try Risk Free
Comments and Help with RESTRICTION
Fill Online
Preview of sample disclosures
Rate free PSC form