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⚠️ Notice: This form may be outdated.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