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Statement And Return Report For Certification

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CMS-838 Medicare Credit Balance Report

www.cms.gov

CERTIFICATION BY OFFICER OR ADMINISTRATOR OF PROVIDER . I HEREBY CERTIFY that I have read the above statements and that I have examined the accompanying credit balance report prepared by: Provider Name Provider 6-Digit Number . for the calendar quarter ended _____ and that it is a true, correct, and complete statement

  Report, Balance, Direct, Testament, Certifications, Credit balance report

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