Change Worksheet Request
The attached enrollment application includes non-material changes to the existing form and I have highlighted those changes below for your convenience. This change will not impact our current burden estimates for completing a PCIP enrollment application because we are not requiring additional information from an applicant we are simply changing the plan year and adding a clarifying verbiage which does not add to the length of time it takes an applicant to read and complete our enrollment application. We anticipate this change will be made November 15, 2011, in anticipation of new applicants that will begin applying for PCIP for the 2012 plan year. We are respectfully request that this request be approved by November 9, 2011, to allow for system changes ahead of the 11/15 date. We understand this change will be submitted under the change worksheet process.
Throughout the document we replaced the year 2011 with 2012.
Plain language revisions such as changing words like “you are” to “you’re”.
Plain language revisions such as presenting the enrollment application in a more logical way – this included deleting page 2 of the instructions and inserting those instructions in more logical places throughout the application. For example, in the page 2 instructions we previously said “when filling out this application, print clearly in blue or black ink” this instruction now appears in the application itself – a more logical way of instructing our users.
In Section 4 “Information about your Medical Condition or Diagnosis” we added the word “specific” to clarify potential misunderstandings that omission of this word may present.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |