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(JE. '.RVI Cf.:, '.+ 'department OF HEALTH & HUMAN SERVICES 'Jttd3oCenters for Medicare & Medicaid ServicesRegion 10 2201 Sixth Avenue, MS/RX 43 Seattle, Washington 98121JAN 11 2012 Douglas Porter,

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cf-q is a form used to report financial information for certain entities.

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Information such as income, expenses, assets, and liabilities must be reported on cf-q.

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