I
116TH CONGRESS
2D SESSION H. R. 5807
To amend title XXVII of the Public Health Service Act, the Internal Revenue
Code of 1986, the Employee Retirement Income Security Act of 1974,
and title XI of the Social Security Act to improve the availability and
accuracy of provider directory information made available by group health
plans and health insurance issuers offering group or individuals health
insurance coverage.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 7, 2020
Mr. LARSON of Connecticut (for himself and Mr. WENSTRUP) introduced the
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and Edu-
cation and Labor, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall within
the jurisdiction of the committee concerned
A BILL
To amend title XXVII of the Public Health Service Act,
the Internal Revenue Code of 1986, the Employee Retire-
ment Income Security Act of 1974, and title XI of the
Social Security Act to improve the availability and accu-
racy of provider directory information made available
by group health plans and health insurance issuers offer-
ing group or individuals health insurance coverage.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
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SECTION 1. SHORT TITLE. 1
This Act may be cited as the ‘‘Know Your Provider 2
Act of 2020’’. 3
SEC. 2. IMPROVING THE AVAILABILITY AND ACCURACY OF 4
PROVIDER DIRECTORY INFORMATION MADE 5
AVAILABLE BY GROUP HEALTH PLANS AND 6
HEALTH INSURANCE ISSUERS OFFERING 7
GROUP OR INDIVIDUALS HEALTH INSUR-8
ANCE COVERAGE. 9
(a) GROUP HEALTH PLAN AND HEALTH INSURANCE 10
ISSUER REQUIREMENTS.— 11
(1) PUBLIC HEALTH SERVICE ACT.—Subpart II 12
of part A of title XXVII of the Public Health Serv-13
ice Act (42 U.S.C. 300gg–11 et seq.) is amended by 14
adding at the end the following new section: 15
‘‘SEC. 2730. PROVIDER DIRECTORY REQUIREMENTS. 16
‘‘(a) IN GENERAL.—Beginning not later than Janu-17
ary 1, 2022, each group health plan and health insurance 18
issuer offering group or individual health insurance cov-19
erage shall— 20
‘‘(1) establish the verification process described 21
in subsection (b); 22
‘‘(2) establish the response protocol described in 23
subsection (c); 24
‘‘(3) establish the database described in sub-25
section (d); and 26
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‘‘(4) include in any directory (other than the 1
database described in paragraph (3)) containing pro-2
vider directory information with respect to such plan 3
or such coverage the information described in sub-4
section (e). 5
‘‘(b) VERIFICATION PROCESS.—The verification 6
process described in this subsection is, with respect to a 7
group health plan or a health insurance issuer offering 8
group or individual health insurance coverage, a process— 9
‘‘(1) under which such plan or such issuer (as 10
applicable) verifies and updates the provider direc-11
tory information included on the database described 12
in subsection (d) of such plan or issuer of— 13
‘‘(A) not less frequently than once every 90 14
days, a random sample of at least 10 percent 15
of health care providers and health care facili-16
ties included in such database; and 17
‘‘(B) any such provider or such facility in-18
cluded in such database that has not submitted 19
any claim to such plan or such issuer (as appli-20
cable) during a 12-month period; 21
‘‘(2) that establishes a procedure for the re-22
moval from such database of such a provider or fa-23
cility with respect to which such plan or issuer has 24
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been unable to verify such information during a pe-1
riod specified by the plan or issuer; and 2
‘‘(3) that provides for the update of such data-3
base within 2 business days of such plan or such 4
issuer (as applicable) receiving from such a provider 5
or facility information pursuant to section 1150C of 6
the Social Security Act. 7
‘‘(c) RESPONSE PROTOCOL.—The response protocol 8
described in this subsection is, in the case of an individual 9
enrolled under a group health plan or group or individual 10
health insurance coverage offered by a health insurance 11
issuer who requests information through a telephone call 12
or email on whether a health care provider or health care 13
facility has a contractual relationship to furnish items and 14
services under such plan or such coverage, a protocol 15
under which such plan or such issuer (as applicable)— 16
‘‘(1) responds to such individual as soon as 17
practicable, and in no case later than 1 business day 18
after such call or email is received, through a writ-19
ten electronic communication; and 20
‘‘(2) retains such communication in such indi-21
vidual’s file for at least 2 years following such re-22
sponse. 23
‘‘(d) DATABASE.—The database described in this 24
subsection is, with respect to a group health plan or health 25
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insurance issuer offering group or individual health insur-1
ance coverage, a database on the public website of such 2
plan or issuer that contains— 3
‘‘(1) a list of each health care provider and 4
health care facility with which such plan or such 5
issuer has a contractual relationship for furnishing 6
items and services under such plan or such coverage; 7
and 8
‘‘(2) provider directory information with respect 9
to each such provider and facility. 10
‘‘(e) INFORMATION.—The information described in 11
this subsection is, with respect to a directory containing 12
provider directory information with respect to a group 13
health plan or individual or group health insurance cov-14
erage offered by a health insurance issuer, a notification 15
that such information contained in such directory was ac-16
curate as of the date of publication of such directory and 17
that an individual enrolled under such plan or such cov-18
erage should consult the database described in subsection 19
(d) with respect to such plan or such coverage or contact 20
such plan or the issuer of such coverage to obtain the most 21
current provider directory information with respect to 22
such plan or such coverage. 23
‘‘(f) DEFINITION.—For purposes of this section, the 24
term ‘provider directory information’ includes, with re-25
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spect to a group health plan and a health insurance issuer 1
offering group or individual health insurance coverage, the 2
name, address, specialty, and telephone number of each 3
health care provider or health care facility with which such 4
plan or such issuer has a contractual relationship for fur-5
nishing items and services under such plan or such cov-6
erage.’’. 7
(2) INTERNAL REVENUE CODE OF 1986.— 8
(A) IN GENERAL.—Subchapter B of chap-9
ter 100 of the Internal Revenue Code of 1986 10
is amended by adding at the end the following 11
new section: 12
‘‘SEC. 9816. PROVIDER DIRECTORY REQUIREMENTS. 13
‘‘(a) IN GENERAL.—Beginning not later than Janu-14
ary 1, 2022, each group health plan shall— 15
‘‘(1) establish the verification process described 16
in subsection (b); 17
‘‘(2) establish the response protocol described in 18
subsection (c); 19
‘‘(3) establish the database described in sub-20
section (d); and 21
‘‘(4) include in any directory (other than the 22
database described in paragraph (3)) containing pro-23
vider directory information with respect to such plan 24
the information described in subsection (e). 25
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‘‘(b) VERIFICATION PROCESS.—The verification 1
process described in this subsection is, with respect to a 2
group health plan, a process— 3
‘‘(1) under which such plan verifies and updates 4
the provider directory information included on the 5
database described in subsection (d) of such plan 6
of— 7
‘‘(A) not less frequently than once every 90 8
days, a random sample of at least 10 percent 9
of health care providers and health care facili-10
ties included in such database; and 11
‘‘(B) any such provider or such facility in-12
cluded in such database that has not submitted 13
any claim to such plan during a 12-month pe-14
riod; 15
‘‘(2) that establishes a procedure for the re-16
moval from such database of such a provider or fa-17
cility with respect to which such plan has been un-18
able to verify such information during a period spec-19
ified by the plan; and 20
‘‘(3) that provides for the update of such data-21
base within 2 business days of such plan receiving 22
from such a provider or facility information pursu-23
ant to section 1150C of the Social Security Act. 24
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‘‘(c) RESPONSE PROTOCOL.—The response protocol 1
described in this subsection is, in the case of an individual 2
enrolled under a group health plan who requests informa-3
tion through a telephone call or email on whether a health 4
care provider or health care facility has a contractual rela-5
tionship to furnish items and services under such plan, 6
a protocol under which such plan— 7
‘‘(1) responds to such individual as soon as 8
practicable, and in no case later than 1 business day 9
after such call or email is received, through a writ-10
ten electronic communication; and 11
‘‘(2) retains such communication in such indi-12
vidual’s file for at least 2 years following such re-13
sponse. 14
‘‘(d) DATABASE.—The database described in this 15
subsection is, with respect to a group health plan, a data-16
base on the public website of such plan that contains— 17
‘‘(1) a list of each health care provider and 18
health care facility with which such plan has a con-19
tractual relationship for furnishing items and serv-20
ices under such plan; and 21
‘‘(2) provider directory information with respect 22
to each such provider and facility. 23
‘‘(e) INFORMATION.—The information described in 24
this subsection is, with respect to a directory containing 25
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provider directory information with respect to a group 1
health plan, a notification that such information contained 2
in such directory was accurate as of the date of publication 3
of such directory and that an individual enrolled under 4
such plan should consult the database described in sub-5
section (d) with respect to such plan or contact such plan 6
to obtain the most current provider directory information 7
with respect to such plan. 8
‘‘(f) DEFINITION.—For purposes of this section, the 9
term ‘provider directory information’ includes, with re-10
spect to a group health plan, the name, address, specialty, 11
and telephone number of each health care provider or 12
health care facility with which such plan has a contractual 13
relationship for furnishing items and services under such 14
plan or such coverage.’’. 15
(B) CONFORMING AMENDMENT.—Section 16
9815(a) of the Internal Revenue Code of 1986 17
is amended— 18
(i) in paragraph (1), by striking ‘‘(as 19
amended by the Patient Protection and Af-20
fordable Care Act)’’ and inserting ‘‘(other 21
than the provisions of section 2730 of such 22
Act)’’; and 23
(ii) in paragraph (2), by inserting 24
‘‘(other than the provisions of section 2730 25
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of such Act)’’ after the first occurrence of 1
‘‘such part A’’. 2
(C) CLERICAL AMENDMENT.—The table of 3
sections for such subchapter is amended by 4
adding at the end the following new items: 5
‘‘Sec. 9815. Additional market reforms.
‘‘Sec. 9816. Provider directory requirements.’’.
(3) EMPLOYEE RETIREMENT INCOME SECURITY 6
ACT OF 1974.— 7
(A) IN GENERAL.—Subpart B of part 7 of 8
subtitle B of title I of the Employee Retirement 9
Income Security Act of 1974 (29 U.S.C. 1185 10
et seq.) is amended by adding at the end the 11
following new section: 12
‘‘SEC. 716. PROVIDER DIRECTORY REQUIREMENTS. 13
‘‘(a) IN GENERAL.—Beginning not later than Janu-14
ary 1, 2022, each group health plan and health insurance 15
issuer offering group health insurance coverage shall— 16
‘‘(1) establish the verification process described 17
in subsection (b); 18
‘‘(2) establish the response protocol described in 19
subsection (c); 20
‘‘(3) establish the database described in sub-21
section (d); and 22
‘‘(4) include in any directory (other than the 23
database described in paragraph (3)) containing pro-24
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•HR 5807 IH
vider directory information with respect to such plan 1
or such coverage the information described in sub-2
section (e). 3
‘‘(b) VERIFICATION PROCESS.—The verification 4
process described in this subsection is, with respect to a 5
group health plan or a health insurance issuer offering 6
group health insurance coverage, a process— 7
‘‘(1) under which such plan or such issuer (as 8
applicable) verifies and updates the provider direc-9
tory information included on the database described 10
in subsection (d) of such plan or issuer of— 11
‘‘(A) not less frequently than once every 90 12
days, a random sample of at least 10 percent 13
of health care providers and health care facili-14
ties included in such database; and 15
‘‘(B) any such provider or such facility in-16
cluded in such database that has not submitted 17
any claim to such plan or such issuer (as appli-18
cable) during a 12-month period; 19
‘‘(2) that establishes a procedure for the re-20
moval from such database of such a provider or fa-21
cility with respect to which such plan or issuer has 22
been unable to verify such information during a pe-23
riod specified by the plan or issuer; and 24
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‘‘(3) that provides for the update of such data-1
base within 2 business days of such plan or such 2
issuer (as applicable) receiving from such a provider 3
or facility information pursuant to section 1150C of 4
the Social Security Act. 5
‘‘(c) RESPONSE PROTOCOL.—The response protocol 6
described in this subsection is, in the case of an individual 7
enrolled under a group health plan or group health insur-8
ance coverage offered by a health insurance issuer who 9
requests information through a telephone call or email on 10
whether a health care provider or health care facility has 11
a contractual relationship to furnish items and services 12
under such plan or such coverage, a protocol under which 13
such plan or such issuer (as applicable)— 14
‘‘(1) responds to such individual as soon as 15
practicable, and in no case later than 1 business day 16
after such call or email is received, through a writ-17
ten electronic communication; and 18
‘‘(2) retains such communication in such indi-19
vidual’s file for at least 2 years following such re-20
sponse. 21
‘‘(d) DATABASE.—The database described in this 22
subsection is, with respect to a group health plan or health 23
insurance issuer offering group health insurance coverage, 24
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a database on the public website of such plan or issuer 1
that contains— 2
‘‘(1) a list of each health care provider and 3
health care facility with which such plan or such 4
issuer has a contractual relationship for furnishing 5
items and services under such plan or such coverage; 6
and 7
‘‘(2) provider directory information with respect 8
to each such provider and facility. 9
‘‘(e) INFORMATION.—The information described in 10
this subsection is, with respect to a directory containing 11
provider directory information with respect to a group 12
health plan or group health insurance coverage offered by 13
a health insurance issuer, a notification that such informa-14
tion contained in such directory was accurate as of the 15
date of publication of such directory and that an individual 16
enrolled under such plan or such coverage should consult 17
the database described in subsection (d) with respect to 18
such plan or such coverage or contact such plan or the 19
issuer of such coverage to obtain the most current provider 20
directory information with respect to such plan or such 21
coverage. 22
‘‘(f) DEFINITION.—For purposes of this section, the 23
term ‘provider directory information’ includes, with re-24
spect to a group health plan and a health insurance issuer 25
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offering group health insurance coverage, the name, ad-1
dress, specialty, and telephone number of each health care 2
provider or health care facility with which such plan or 3
such issuer has a contractual relationship for furnishing 4
items and services under such plan or such coverage.’’. 5
(B) CONFORMING AMENDMENT.—Section 6
715(a) of the Employee Retirement Income Se-7
curity Act of 1974 (29 U.S.C. 1185d(a)) is 8
amended— 9
(i) in paragraph (1), by striking ‘‘(as 10
amended by the Patient Protection and Af-11
fordable Care Act)’’ and inserting ‘‘(other 12
than the provisions of section 2730 of such 13
Act)’’; and 14
(ii) in paragraph (2), by inserting 15
‘‘(other than the provisions of section 2730 16
of such Act)’’ after the first occurrence of 17
‘‘such part A’’. 18
(C) CLERICAL AMENDMENT.—The table of 19
contents in section 1 of the Employee Retire-20
ment Income Security Act of 1974 is amended 21
by inserting after the item relating to section 22
714 the following new items: 23
‘‘Sec. 715. Additional market reforms.
‘‘Sec. 716. Provider directory requirements.’’.
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(b) HEALTH CARE PROVIDERS.—Part A of title XI 1
of the Social Security Act (42 U.S.C. 13010 et seq.) is 2
amended by adding at the end the following new section: 3
‘‘SEC. 1150C. SUBMISSION OF INFORMATION TO HEALTH 4
PLANS OF CERTAIN PROVIDER INFORMA-5
TION. 6
‘‘(a) IN GENERAL.—Beginning not later than 1 year 7
after the date of the enactment of this section, each health 8
care provider and health care facility shall establish a 9
process under which such provider or facility transmits, 10
to each health insurance issuer offering group or indi-11
vidual health insurance coverage and group health plan 12
with which such provider or supplier has in effect a con-13
tractual relationship for furnishing items and services 14
under such coverage or such plan, provider directory infor-15
mation (as defined in section 2730(e) of the Public Health 16
Service Act, section 716(e) of the Employee Retirement 17
Income Security Act of 1974, or section 9816(e) of the 18
Internal Revenue Code of 1986, as applicable) with re-19
spect to such provider or facility, as applicable. Such pro-20
vider or facility shall so transmit such information to such 21
issuer offering such coverage or such group health plan— 22
‘‘(1) when there are any material changes (in-23
cluding a change in address, telephone number, or 24
other contact information) to such provider directory 25
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•HR 5807 IH
information of the provider or facility with respect to 1
such coverage offered by such issuer or with respect 2
to such plan; and 3
‘‘(2) at any other time (including upon the re-4
quest of such issuer or plan) determined appropriate 5
by the provider, facility, or the Secretary. 6
‘‘(b) PENALTY.— 7
‘‘(1) IN GENERAL.—Each health care provider 8
or health care facility that fails to transmit informa-9
tion as required under subsection (a) shall be subject 10
to a civil monetary penalty of $1,000 for each day 11
such provider or facility (as applicable) fails to so 12
transmit such information. 13
‘‘(2) APPLICATION OF PROVISIONS.—The provi-14
sions of section 1128A (other than subsection (a), 15
subsection (b), the first sentence of subsection 16
(c)(1), subsection (d), and subsection (o)) shall 17
apply with respect to a civil monetary penalty im-18
posed under this subsection in the same manner as 19
such provisions apply with respect to a penalty or 20
proceeding under subsection (a) of such section. 21
‘‘(c) DEFINITIONS.—In this section, the terms ‘health 22
insurance issuer’, ‘group health plan’, ‘group health insur-23
ance coverage’, and ‘individual health insurance coverage’ 24
have the meaning given such terms, respectively, in section 25
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2791 of the Public Health Service Act (42 U.S.C. 300gg– 1
91 et seq.).’’. 2
Æ
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/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/JPEG2000ColorACSImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/JPEG2000ColorImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/AntiAliasGrayImages false
/CropGrayImages true
/GrayImageMinResolution 300
/GrayImageMinResolutionPolicy /OK
/DownsampleGrayImages false
/GrayImageDownsampleType /Bicubic
/GrayImageResolution 300
/GrayImageDepth 8
/GrayImageMinDownsampleDepth 2
/GrayImageDownsampleThreshold 1.50000
/EncodeGrayImages true
/GrayImageFilter /FlateEncode
/AutoFilterGrayImages false
/GrayImageAutoFilterStrategy /JPEG
/GrayACSImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/GrayImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/JPEG2000GrayACSImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/JPEG2000GrayImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/AntiAliasMonoImages false
/CropMonoImages true
/MonoImageMinResolution 1200
/MonoImageMinResolutionPolicy /OK
/DownsampleMonoImages false
/MonoImageDownsampleType /Bicubic
/MonoImageResolution 1200
/MonoImageDepth -1
/MonoImageDownsampleThreshold 1.50000
/EncodeMonoImages true
/MonoImageFilter /CCITTFaxEncode
/MonoImageDict <<
/K -1
>>
/AllowPSXObjects false
/CheckCompliance [
/None
]
/PDFX1aCheck true
/PDFX3Check false
/PDFXCompliantPDFOnly true
/PDFXNoTrimBoxError false
/PDFXTrimBoxToMediaBoxOffset [
0.00000
0.00000
0.00000
0.00000
]
/PDFXSetBleedBoxToMediaBox true
/PDFXBleedBoxToTrimBoxOffset [
0.00000
0.00000
0.00000
0.00000
]
/PDFXOutputIntentProfile (U.S. Web Coated \050SWOP\051 v2)
/PDFXOutputConditionIdentifier (CGATS TR 001)
/PDFXOutputCondition ()
/PDFXRegistryName (http://www.color.org)
/PDFXTrapped /False
/CreateJDFFile false
/Description <<
/ARA
/BGR
/CHS
/CHT
/CZE
/DAN
/DEU
/ESP
/ETI
/FRA
/GRE
/HEB
/HRV
/HUN
/ITA (Utilizzare queste impostazioni per creare documenti Adobe PDF che devono essere conformi o verificati in base a PDF/X-1a:2001, uno standard ISO per lo scambio di contenuto grafico. Per ulteriori informazioni sulla creazione di documenti PDF compatibili con PDF/X-1a, consultare la Guida dell'utente di Acrobat. I documenti PDF creati possono essere aperti con Acrobat e Adobe Reader 4.0 e versioni successive.)
/JPN
/KOR
/LTH
/LVI
/NLD (Gebruik deze instellingen om Adobe PDF-documenten te maken die moeten worden gecontroleerd of moeten voldoen aan PDF/X-1a:2001, een ISO-standaard voor het uitwisselen van grafische gegevens. Raadpleeg de gebruikershandleiding van Acrobat voor meer informatie over het maken van PDF-documenten die compatibel zijn met PDF/X-1a. De gemaakte PDF-documenten kunnen worden geopend met Acrobat en Adobe Reader 4.0 en hoger.)
/NOR
/POL
/PTB
/RUM
/RUS
/SKY
/SLV
/SUO
/SVE
/TUR
/UKR
/ENU (Use these settings to create Adobe PDF documents that are to be checked or must conform to PDF/X-1a:2001, an ISO standard for graphic content exchange. For more information on creating PDF/X-1a compliant PDF documents, please refer to the Acrobat User Guide. Created PDF documents can be opened with Acrobat and Adobe Reader 4.0 and later.)
>>
/Namespace [
(Adobe)
(Common)
(1.0)
]
/OtherNamespaces [
<<
/AsReaderSpreads false
/CropImagesToFrames true
/ErrorControl /WarnAndContinue
/FlattenerIgnoreSpreadOverrides false
/IncludeGuidesGrids false
/IncludeNonPrinting false
/IncludeSlug false
/Namespace [
(Adobe)
(InDesign)
(4.0)
]
/OmitPlacedBitmaps false
/OmitPlacedEPS false
/OmitPlacedPDF false
/SimulateOverprint /Legacy
>>
<<
/AddBleedMarks false
/AddColorBars false
/AddCropMarks false
/AddPageInfo false
/AddRegMarks false
/ConvertColors /ConvertToCMYK
/DestinationProfileName ()
/DestinationProfileSelector /DocumentCMYK
/Downsample16BitImages true
/FlattenerPreset <<
/PresetSelector /HighResolution
>>
/FormElements false
/GenerateStructure false
/IncludeBookmarks false
/IncludeHyperlinks false
/IncludeInteractive false
/IncludeLayers false
/IncludeProfiles false
/MultimediaHandling /UseObjectSettings
/Namespace [
(Adobe)
(CreativeSuite)
(2.0)
]
/PDFXOutputIntentProfileSelector /DocumentCMYK
/PreserveEditing true
/UntaggedCMYKHandling /LeaveUntagged
/UntaggedRGBHandling /UseDocumentProfile
/UseDocumentBleed false
>>
]
>> setdistillerparams
<<
/HWResolution [2400 2400]
/PageSize [612.000 792.000]
>> setpagedevice
Superintendent of Documents
2020-02-12T22:27:35-0500
US GPO, Washington, DC 20401
Superintendent of Documents
GPO attests that this document has not been altered since it was disseminated by GPO