Document

Form CMS-R-0235A

ICR 202505-0938-012 · OMB 0938-0734 · Object 158261401.

Document Viewer [docx]

Status: The document is viewable, but some background extraction is still pending.

Queue: Repair is queued and waiting for the next worker pass. (priority 70 · next 2026-05-27 18:56:31)

Missing: html

Download: Source copy (docx)

Primary: docxSource: application/vnd.openxmlformats-officedocument.wordprocessingml.document
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Document Metadata
File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleForm CMS-R-0235A
AuthorRebecca Dorman
File Created2026-01-02
Conversion Statepartial