CMS-10495 Assumptions

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

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

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

[Type here]
Select criteria for file upload

Successful File Upload

2

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

[Type here]

Payments passed file level validation check and ready for FINAL Submission

Final Submission Button Enabled for final Submission

3

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

[Type here]

Final Submission Confirmation

Post Final Submission Confirmation

4

[Type here]

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

Begin Attestation

Attestation-Confirm Payments

5

[Type here]

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

Add Assumptions Yes/No?

Add Assumptions- Yes workflow

6

[Type here]

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

Assumptions Added

Agree To Attestation

7

[Type here]

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

Agree to Attestation_Cont

Agree to Attestation_Cont

8

[Type here]

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

Review and Attest

Review and Attest

9

[Type here]

OMB Control No:
0938-1237 Expiration Date:
XX/20XX

Records shown as attested

10