Form CMS-10495 Attestation
Registration, Attestation, Assumptions Document and Data Retention Requirements for Open Payments
Attestation Submission screen shots (starting on page 7)
AM and Applicable GPO (Attestation)
OMB: 0938-1237
Screen Shots Submission Flow
The screen shots below illustrate the workflow (submission + Attestation) of a user uploading a file containing general payments records.
File Upload-General Payments
Select criteria for file upload
Successful File Upload
Payments passed file level validation check and ready for FINAL Submission
Final Submission Button Enabled for final Submission
Final Submission Confirmation
Post Final Submission Confirmation
Begin Attestation
Attestation-Confirm Payments
Add Assumptions Yes/No?
Add Assumptions- Yes workflow
Assumptions Added
Agree To Attestation
Agree to Attestation_Cont
Agree to Attestation_Cont
Review and Attest
Review and Attest
Records shown as attested
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Birgach, Elmehdi |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |
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