Document
Attachment 1 - Compensation Certification
ICR 200905-0938-002 · OMB 0938-0964 · Object 11875501.
This document may belong to an older filing. More recent activity for OMB 0938-0964:
Document Viewer [doc]
Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Attachment 1 - Compensation Certification |
| Author | Gerard Mulcahy |
| Last Modified By | Writer |
| File Modified | 2008-11-07 |
| File Created | 2026-10-06 |
| Conversion State | complete |
Extracted Text
Attachment 1a - To be completed by all Organizations 2009 Compensation Certification Organization Name:________________________________________ Certification Date:_______________________________________ CMS Contract Number(s):___________________________________ I have examined the compensation structure(s) described herein and attest that this accurately and completely represents the compensation structure(s) as of the certification date indicated on this document. The structure(s) herein meet the requirements set in CMS 4138-IFC2. __________________________________ ___________ CEO (or other authorized official) Date Attachment 1b – To be completed by Organizations using Option One to determine 2009 renewal commissions 2009 Compensation Certification Organization Name:________________________________________ Certification Date:_______________________________________ CMS Contract Number(s):___________________________________ I have examined the compensation structure(s) for 2006 described herein and attest that this accurately and completely represents the initial compensation structure(s) in place at that time, and that the renewal compensation rate submitted for 2009 is 50% of the 2006 initial rate adjusted for inflation factors provided in CMS guidance on 2009 compensation structures. The structure(s) herein meet the requirements set in CMS 4138-IFC2. __________________________________ ___________ CEO (or other authorized official) Date