Semi-Annual Interim Cost Report

Revisions Crosswalk (Form 276-19)
Interim Reporting
Note: In the Changes to Application column, the quoted words are what are to be entered. Example in issue #1 is “276-19”, do not enter the words that
explain the change and that are outside of the quotations.
Issue
Page #
#
1.
Worksheet S

Section
Row 59

2.

Worksheet S

Row 68

3.

Worksheet C

Row 33

Action to be
performed
Change form
number
Change Date
Change form
number

Changes to the Application

Reason for the Change

Changed form number 276-16 to “276-19”.

To reflect the most recent change in the
form number/year
Pending approval of the PRA package
renewal.
To reflect the most recent change in the
form number/year.

Changed Form Expiration Date: 12/31/2019 to
“12/31/2022”
Changed form number 276-16 to “276-19”.

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