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1.1.3.4 Disclosure of Ownership and Control Interest Statement
The Disclosure of Ownership and Control Interest Statement must be submitted by all providers, excluding the performing providers of a group. This form provides TMHP Provider Enrollment with the appropriate information to enroll the provider as a sole proprietor, corporation, partnership, or nonprofit organization. This information determines if other enrollment forms are required. Providers are required to submit any change in ownership, corporate officers, or directors to TMHP Provider Enrollment within 10 calendar days of the change.
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