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Notice of Adverse Benefit Determination (Notice of Action)

Assigned number Title Release date File type Language Available to order
F-00232I Instructions for Notice of Adverse Benefit Determination (Notice of Action) 12/23/2021 PDF English No
F-00232 Notice of Adverse Benefit Determination (Notice of Action) 12/23/2021 Word English No
F-00232AR Notice of Adverse Benefit Determination (Notice of Action), Arabic 12/23/2021 Word Arabic No
F-00232CM Notice of Adverse Benefit Determination (Notice of Action), Chinese (Simplified) 12/23/2021 Word Chinese (Simplified) No
F-00232H Notice of Adverse Benefit Determination (Notice of Action), Hmong 12/23/2021 Word Hmong No
F-00232L Notice of Adverse Benefit Determination (Notice of Action), Laotian 12/23/2021 Word Lao No
F-00232SE Notice of Adverse Benefit Determination (Notice of Action), Serbo-Croatian 12/23/2021 Word Serbo-Croatian No
F-00232SO Notice of Adverse Benefit Determination (Notice of Action), Somali 12/23/2021 Word Somali No
F-00232S Notice of Adverse Benefit Determination (Notice of Action), Spanish 12/23/2021 Word Spanish No

Glossary

 
Last revised January 30, 2026