Justification for Non-material change-12-18-09

0938-0679

Justification of Non-material and Non-substantive Change (Formerly 83-C)

We are submitting a change worksheet for 0938-0679 to correct a non-material change on form CMS-10269. There is a type in section B of the currently approved version of the form.  The instructions read as “Answer questions 1-6 for initial evaluation;” however, they should read as “Answer questions 1-7 for initial evaluation.” In addition, the numbers should change in the next sentence to read answer questions 8-10.

At this time, we are not making any changes to the other approved forms in this information collection request. Similarly, we are not making any changes that affect the currently approved number of burden hours.