Form CMS-10495 Attestation
Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)
CMS-10495 - Attestation and Assumptions Screen Shots 9.23.2020 - 508 cf
Applicable GPO (Attestation)
OMB: 0938-1237
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1237 can be found here:
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