SCF - Revisions Crosswalk - 10012013

Revisions Crosswalk –Security Consent and Surrogate Authorization Form

Issue #	Page #	Section	Action to be performed	Changes to the Application	Reason for the Change
		Entire Form	Incorporated formatting changes	See change in Actions to be Performed column	Revised the format of the sections to make clearer.
		Entire Form	Added a placeholder for the tracking Id in the top left corner for internal use only	See change in Actions to be Performed column	Added a placeholder tracking Id field for internal tracking purposes.
		Entire Form	Added a placeholder for the OMB/CMS form number in the bottom left corner of each page	See change in Actions to be Performed column	Added a placeholder form Id field.
	1	Section 1– Form Purpose and Instructions	Included additional instructions and definitions for clarification.	See change in Actions to be Performed column	Clarified instructions and definitions for the form purpose.
	4	Section 5A – 3rd Party Organization	Renamed section 5A from Surrogate Organization to 3rd Party Organization. All references to surrogate organization in this section have been changed.	See change in Actions to be Performed column	Added to specify the type of surrogate included in this section.
	4	Section 5B – 3rd Party Individual	Renamed section 5B from Surrogate Individual to 3rd Party Individual. All references to surrogate individual in this section have been changed.	See change in Actions to be Performed column	Added to specify the type of surrogate included in this section.
	4	Section 6 – Required Documentation and Submission Instructions	Added a new section to provide submission instructions	See change in Actions to be Performed column	Clarified what items are required to be submitted with the form and to whom.
	6	Section 7B – Examples	Created a new section to provide examples	See change in Actions to be Performed column	Added to provide example scenarios and what sections of the form would apply in those scenarios.

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Revisions Crosswalk – CMS588 - 04222013