ICR Documents

Supporting Statement A Document Date Uploaded CMS-10169 - Supporting Statement part A (rev 5-10-2013 at 3_00 pm).docx 05/10/2013 Supporting Statement B Document Date Uploaded Supplementary Documents Title Document Document Type Date Uploaded Crosswalk for Application CMS-10169.Crosswalks for Form A.xlsx Supplementary Document 07/25/2012 Network Business Organization Screen Shot 1 Network Business Org Screen View.JPG Supplementary Document 07/25/2012 Business Organization Screenshot 1-Business Org Screen View.JPG Supplementary Document 07/25/2012 Location Specific Screenshot 2-Location Specific Information Screen View.JPG Supplementary Document 07/25/2012 CBAs and Product Category Screenshot 3-CBAs and Product Categories Screen View.JPG Supplementary Document 07/25/2012 Add location screenshot 4-add location Screen View.JPG Supplementary Document 07/25/2012 Additional locations screenshot 5-additional locations Screen View.JPG Supplementary Document 07/25/2012 CBAs and Product Categories 6-cbas and product categories Screen View.JPG Supplementary Document 07/25/2012 Furnished Items screenshot Form B-1.jpg Supplementary Document 07/25/2012 Expansion screenshot Form B-2.jpg Supplementary Document 07/25/2012 Bid Select screenshot Form B-3.jpg Supplementary Document 07/25/2012 Manufacturer screenshot Form B-4.jpg Supplementary Document 07/25/2012 Bid (Certification) screenshot Form B-5.jpg Supplementary Document 07/25/2012 Public Address Announcement screenshot Form B-6.jpg Supplementary Document 07/25/2012 Crosswalk - Form C: Quarterly Report Crosswalk for Changes to Form C.docx Supplementary Document 05/10/2013 Crosswalk -- CONTRACT SUPPLIER'S DISCLOSURE OF SUBCONTRACTORS Crosswalk for Changes to Subcontracting Form.docx Supplementary Document 05/10/2013 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received