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Notice of Adverse Benefit Determination

Assigned number Title Release date File type Language Available to order
F-02721H Notice of Adverse Benefit Determination, Hmong 01/15/2021 Word Hmong No
F-02721S Notice of Adverse Benefit Determination, Spanish 01/15/2021 Word Spanish No
F-02721SO Notice of Adverse Benefit Determination, Somali 01/15/2021 Word Somali No
F-02721 Notice of Adverse Benefit Determination 01/15/2021 Word English No
F-02721R Notice of Adverse Benefit Determination, Russian 01/15/2021 Word Russian No

Glossary

 
Last revised July 12, 2025