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Kansas disclosure 2026
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- Click ‘Get Form’ to open the Kansas Disclosure of Ownership and Control Interest Statement in the editor.
- Begin by filling out the provider entity's name, date of birth, EIN/SSN, and NPI. Ensure all fields are complete to avoid processing delays.
- In Question 1, list all individuals or corporations with a direct or indirect ownership interest of 5% or more. Include their primary address and percentage of ownership.
- For Question 2, indicate if any listed individuals are related. Specify their relationships clearly.
- Continue with Questions 3 through 15, providing detailed information about business transactions, managing employees, criminal convictions, and other required disclosures as specified.
- If additional space is needed for any question, note it on the form and attach a separate sheet referencing the question number.
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