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Disclosure of ownership cms 1513 Form: What You Should Know

Disclosure of Ownership and Control Interest Statement is required at the time of application, application renewal, and¬† application for a new Medicare/Medicaid facility or to re-file. (See¬† Form 2047-D ‚ÄĒ¬†Federal Register, Vol. 66, No. 114,¬† Fees and Expenses (Effective 12/01/2015) ‚ÄĒ Medicare Program.) The individual or organization must also be a Federal or State, tribal or local government entity; a nonprofit, charitable¬† organization; or a private, not- for-profit corporation established for nonprofit, charitable, or political purposes. The form must be completed and¬† signed by the head of the organization or the agent for service of process, and on¬† the form, include and state the name(s) of the entity. The completed form is submitted electronically by submitting it via e-mail to¬† (See the instructions for completing¬† e-mail and paper disclosure requests) C. If you have additional information on the owner or manager;¬† (See instructions for completing disclosure of owner and management interest statement in Form D-56 ‚ÄĒ¬†Federal Register, Vol. 66, No. 109, Item (14), Medicare‚ÄĒMedicare¬† Part D, Payments and Coverage.)¬† F. If any of the following information is not correct, there is no owner or individual;¬† (See instructions for completing disclosure of owner and control interests in form D-55 ‚ÄĒ¬†Federal Register, Vol.¬† 66, No. 123, Item (4), Medicare‚ÄĒMedicare Part D, Payments and¬† Coverage.) The organization or company has no control of the facility, as indicated on Form 2047-D-3S‚ÄĒ¬†Federal Register, Vol.¬†66, No. 114,¬† Fees and Expenses (Effective 12/01/2015) and payment information as indicated on¬† Form 2047-D-3A‚ÄĒfederal register, vol. 66, No.

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