2026 Network 4 Goals Attestation

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1. CCN#/Facility Name (Select from drop down -- Note: Must complete one for each facility)

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2. Enter CCN# and Facility Name if it is not on the drop down list

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3. I acknowledge receipt and reviewed the 2026 Network 4 Goals. (Required.)

Yes

No

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4. Person and email of person completing the attestation? (Required.)