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ATTACHMENT I <br /> Page 1 of 2 <br /> DATA FOR FUTURE DATA MATCH INITIATIVE <br /> Listed below are the data that each Settling Flan will send to HCFA in satisfaction of its <br /> obligations under the Future Data Match Initiative set out in Paragraph C of the <br /> Agreement, incorporated into the Agreement by reference in Paragraph C (3)(b). <br /> INFORMATION ON THE MEDICARE BENEFICIARY <br /> • Beneficiary Name <br /> • Date of Birth <br /> • Sex <br /> • Social Security Number <br /> � Health Insurance Claim Number <br /> • Relationship to Policyholder <br /> - Policyholder <br /> - Spouse of Polieyholder <br /> - Child of Policyholder <br /> - Other relationship to Policyholder <br /> • Reason for Medicare Entitlement <br /> - Beneficiary entitled due to age <br /> - Beneficiary entitled due to disability �' <br /> - Beneficiary entitled due to End Stage Renal Disease (ESRD) , <br /> - Beneficiary entitled due to disability and current ESRD I <br /> INFORMATION ON POLICYHOLDER <br /> • Policyholder Name <br /> • Social Security Number <br /> • Individual Policy Number of Policyholder <br />