CMS059203 | Centers for Medicare & Medicaid Services

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Form #: CMS 10175
Form Title: Electronic File Interchange Organization (EFIO) Certification Statement
Revision Date: 08/01/2006
O.M.B. #: 0938-0984
O.M.B. Expiration Date: 09/30/2012
CMS Manual: N/A
Special Instructions: N/A

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CMS 10175 [PDF, 26KB]

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