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Cms1513_0.pdf - wadsworth center
Participation in this survey and the results of the survey is subject to the provisions of Title 26, United States Code, section 2315(d). †The data reported on will contain personal information from an employee of your company of either the following categories: 1) full or part-time, 2) full-time, part-time, or contractor, or you may select any other criteria. • full name • occupation (please state if you are not a human resource professional or are not sure of the answer). • employee identification # (please know whether you are the primary (in-house) or second billing customer for this employee; if “other” be sure to tell us how you are assigned to this person; please indicate any personal identifying, identifying, identifying factors such as date of birth and occupation). If you prefer to skip answering the first questions or to omit one of them, simply indicate, “I.
Disclosure of ownership and control interest statement
Addressed “Agency Case 888, Intelligence Division, Central Intelligence Agency” (11/16). Addressed “CIA/Agency Case 1083-16” (10/21). Addressed “CIA/Agency Case 938-15” (5/29). Addressed to “Agency Case 982-15” (6/23). Addressed “CIA/Agency Case 991-16” (7/25). Addressed “Agency Case 1001-16” (7/26). Addressed to “Agency Case 983-16” (7/8). Addressed to “CIA/Agency Case (7/9). Addressed “CIA/Agency Case 942-14” (7/17). Addressed “CIA/Agency Case 995-15” (7/19). Addressed “CIA/Agency Case 1012-15” (7/22). Addressed “Agency Case 1019-16” (7/30). Addressed to “Agency Case 1024-15” (8/3). Addressed “CIA/Agency Case 1024-15” (8/1). Note: Only names and not addresses exist on these forms. [Source: ULTRA Documents, p. 49] A. This document was given in two versions. B. All these versions included the following text. CIA/Agency Case 1001-15 INFORMATION RELATING TO THE USE OF THE CHEMICALS IN ULTRA TACTICS By the order of The director, ULTRA was discontinued, on the basis that it is unnecessary, and the current methods are adequate for the conduct of the.
Form approved omb 938-0086/hcfa-1513 - texas
It is required for management and corporate officers. MEMBER-OF-STORY COMPENSATION STATEMENT. This statement is submitted by members of the business (, individuals listed in the members-c-r-a-h table) who are also shareholders of the Corporation (as such term is defined under Section 13(a) of the Exchange Act). MERGER AGREEMENT STATEMENT. This is the Agreement or agreements that the Board of Directors has. It should be presented separately for each board member and member of the partnership. The document in which the Board of Directors is an interested person must not be submitted as a part of this statement. MISCELLANEOUS STATEMENTS. These items may be entered as required by Section 13(l) of the Exchange Act and Section 13(c) of the Exchange Act (16 §(l)). SECURITY-INFORMATION STATEMENT. This is the Statement prepared in response to a request by the United States Securities and Exchange Commission (SEC) relating to the acquisition by the Corporation of the interests.
Department of health & human services - cms
To the extent an investment in a security or commodity is dependent on its future price, a financial disclosure form is required to identify all members of management and significant contributors of capital and other funds used to purchase such security or commodity. We are releasing an annual report today on our Form 8-K filing with the SEC to inform investors about our management's and investment partners' interests in securities and commodities. This annual report is also available on our Investor Relations website at, but in this release, we are releasing a form we previously filed with the SEC, a Form 25-F, Disclosure Statement. To provide investors with an opportunity to review and comment on the Form 25-F, we are making an interim filing with the SEC that was filed on January 25, 2014, as filed on Form 8-K. We are now providing this Form 5-K. The Form 5-K.
Disclosure of ownership and control interest
Federally regulated health plan or issuer).  (Health insurance issuer). Number. Type of plan.  (Self-insured, managed care, small, large group, etc.) LB7. Name. Address. Provider Number. Form HCFA-1513 (5-86) Page 2 (Optional). Number. Type of plan. (Self-insured, managed care, small, large group, etc.) LB7. Name. Address. Provider Number. Form HCFA-1513 (5-86) Page 3.  (Optional). List names, addresses of individuals and provider numbers. Yes No LB7: Name. Address. Provider Number. Form HCFA-1513 (5-86) Page 6 (Optional). Yes. Yes. Type of plan. (Self-insured, managed care, small, large group, etc.) LB7: Name. Address. Provider Number. Form HCFA-1513 (5-86) Page 7.  (Optional).  List names, addresses of individuals and provider numbers. Yes No LB7: Name. Address. Provider Number. Form HCFA-1513 (5-86) Page 8 (Optional).  List names, addresses of individuals and provider numbers. Yes No LB7: Name. Address. Provider Number. Form HCFA-1513 (5-86) Page 9 (Optional). Yes. Address. Yes Yes. Type of plan. (Self-insured, managed care,.