Crosswalk

ICF/IID PRA Package Form Changes Document

Form CMS-3070 G

OMB NO. 0938-0062

1. Change in title from Intermediate Care Facilities for Individuals with Mental Retardation Survey Report to Intermediate Care Facilities for Individuals with Intellectual Disabilities Survey Report- Change made due to change in statue language

2. Block 13. Change ICF/MR to ICF/IID- Change made due to change in statute language

3. Block 15. Change QMRP to QIDP- Change made to parallel statute language

4. Block 15 O. Change QMRP to QIDP- Change made to parallel statute language

5. Block 16A. Change ICF/MR to ICF/IID- Change made due to change in statute language

6. Block 16B. Change ICF/MR to ICF/IID- Change made due to change in statute language

7. Block 16C. Change ICF/MR to ICF/IID- Change made due to change in statue language

8. Block 16D. Change ICF/MR to ICF/IID- Change made due to change in statue language

9. Block 16E. Change ICF/MR to ICF/IID- Change made due to change in statue language

10. Block 16H. Change ICF/MR to ICF/IID- Change made to change in statue language

11. Block 20D (1). Change Mental Retardation to Intellectual Disability- Change made due to change in statute language

Form CMS- 3070 H

OMB NO. 0938-0062

1. Change in title from Intermediate Care Facility for Persons with Mental Retardation Deficiencies Report to Intermediate Care Facility for Individuals With Intellectual Disabilities Deficiencies Report- Change made due to change in statute language

2. Block 2. Change COP to CoP- Change made to correct grammatical error

Form CMS- 3070 I

OMB NO. 0038-0062

There were no changes to this form.