CMS-276.Crosswalk for Revisions to Budget Forecast

CMS-276.Crosswalk for Revisions to Budget Forecast.doc

Prepaid Health Plan Cost Report

CMS-276.Crosswalk for Revisions to Budget Forecast

OMB: 0938-0165

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Revisions Crosswalk (Form CMS-276-08)

Budget Forecast



Issue #

Page #

Section

Action to be performed

Changes to the Application

Reason for the Change

1

Worksheet A, Parts I & II

Add the following after 7

7a: Accretion/Deletion, 7b Cost Report Certification, 7c Other:

To list all special administration costs

1

Worksheet B,

Part II

Change the title of Part II

Change to: PART II -UNDER/OVER COLLECTION FOR BUDGET PERIOD

For clarification purposes

1

Worksheet B,

Part II

Change Line 7, Part II

Change to: Voluntary under or (Over ) (Line 5 minus Line 6)


For clarification purposes


Page 1 of 1

File Typeapplication/msword
File TitleIssue #
AuthorCMS
Last Modified ByCMS
File Modified2009-05-05
File Created2009-05-05

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