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ANNUAL PROVIDER AND MANUFACTURER SELF-ATTESTATION STATEMENT (VERSION 1.0)
ICR 202409-0920-015 · OMB unassigned · Object 146634301.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | ANNUAL PROVIDER AND MANUFACTURER SELF-ATTESTATION STATEMENT (VERSION 1.0) |
| Author | Lin-Gibson, Sheng (Fed) |
| File Created | 2024-12-01 |
| Conversion State | partial |