4. Tri-dept - notice of certified IDR entity selection (data elements) clean 9.28.21

No Surprises Act: IDR Process

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0169 can be found here:

Document [docx]

Download: docx | pdf

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Elizabeth Schumacher
File Modified	0000-00-00
File Created	2022-04-12