Certification - (Rev. 5, 08-30-02)

300 - Certification - (Rev. 5, 08-30-02) A1-1932, A1-1952, B1-4932, B1-4952 Medicare contractor certification by the CFO is required. The CFO must input their password on the CAFM system (see Exhibit 16). Failure to record the official's password is a serious error that will prevent acceptance of the report by the CAFM system. The following statement appears at the end of the Form CMS-C751A/B (as well as the Form CMS-MC751A/B): I hereby CERTIFY that I have examined the Status of Non-MSP Debt - CNC prepared by name of contractor for the period beginning (first day of FY) and ending (last day of quarter), and that to the best of my knowledge and belief, it is a true, correct and complete statement prepared from the books and records of the contractor in accordance with applicable instructions. NAME _____________________ DATE _______ TITLE _________ NOTE: In the above statement, "MSP" replaces "Non-MSP" for the MSP report.