| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-02721 | Notice of Adverse Benefit Determination (Word) | 01/15/2021 | English | No |
| F-02721H | Notice of Adverse Benefit Determination, Hmong (Word) | 01/15/2021 | Hmong | No |
| F-02721R | Notice of Adverse Benefit Determination, Russian (Word) | 01/15/2021 | Russian | No |
| F-02721SO | Notice of Adverse Benefit Determination, Somali (Word) | 01/15/2021 | Somali | No |
| F-02721S | Notice of Adverse Benefit Determination, Spanish (Word) | 01/15/2021 | Spanish | No |
Last revised September 18, 2026