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OMB Control Number 09381401 Expiration Date MM/DD/YYY Appendix 2 Standard Form: Good Faith Estimate for Health Care Items and Services Under the No Surprises Act (For use by health care providers
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How to fill out wwwcmsgovfilesdocumentmodel disclosure notice regarding

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What is wwwcmsgovfilesdocumentmodel disclosure notice regarding?
The wwwcmsgovfilesdocumentmodel disclosure notice is regarding the disclosure of certain financial interests.
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Individuals holding certain positions or with certain financial interests are required to file wwwcmsgovfilesdocumentmodel disclosure notice.
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Information such as financial assets, liabilities, positions held, and sources of income must be reported on wwwcmsgovfilesdocumentmodel disclosure notice.
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