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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