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ICF/IID Survey Report Form (CMS-3070G-I) and Supporting Regulations

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OMB: 0938-0062

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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.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorADRIENNE ROGERS
File Modified0000-00-00
File Created2021-01-23

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