Form CMS-10621 QCDR Self-nomination form

(CMS-10621) Merit-based Incentive Payment System

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1314 can be found here:

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Appendix D: QCDR Self-Nomination Form

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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Mitch Bryman
File Modified	0000-00-00
File Created	2021-01-23