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Therefore, we are not proposing any adjustments in burden because we assume the additional cost requirement would not add significant burden to the currently approved 10 hours per application first established in the CY 2018 Quality Payment Program final rule (82 FR 30216)

Natl Cancer Inst

We would issue a revised initial determination to the ACO with the recalculated payment determination for the performance year

According to the Tobacco-specific nitrosamines (TSNAs) are the strongest of the cancer-causing substances in smokeless tobacco