- Form #
- CMS 10252
- Form Title
- DATA USE AGREEMENT (DUA) CERTFICATE OF DISPOSITION (COD) FOR DATA ACQUIRED FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
- Revision Date
- 05/29/2012
- O.M.B. #
- 0938-1046
- O.M.B. Expiration Date
- 09/30/2014
- CMS Manual
- N/A
- Special Instructions
- N/A
