Cms-1490s
CMS-1490S (1-2005).pdf
Request for Medicare Payment
CMS-1490S
OMB: 3220-0131
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0131 can be found here:
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| File Type | application/pdf |
| File Modified | 2006-06-27 |
| File Created | 2006-06-27 |