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Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Subm

ICR 202605-0938-004 · OMB 0938-1314 · Object 168709300.

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Document Metadata
File Typeapplication/octet-stream
File TitleSubmission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Subm
KeywordsSubmission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Subm
AuthorHHS/CMS
Last Modified ByMicrosoft® Word for Microsoft 365
File Modified2025-08-07
File Created2025-05-21
Conversion Statecomplete