Download:
pdf |
pdfRevisions Crosswalk (Form 276-22)
Interim Reporting
Note: In the Changes to Application column, the quoted words are what are to be entered. Example in issue #1 is “276-22”, do not enter the words that
explain the change and that are outside of the quotations.
Issue
Page #
#
1.
Worksheet S
Section
2.
Worksheet S
Row 68
3.
Worksheet C
Row 33
Row 59
Action to be
performed
Change form
number
Remove
Change form
number
Changes to the Application
Reason for the Change
Changed form number 276-19 to “276-22”.
To reflect the most recent change in the
form number/year
This date is not determined until approval
of the PRA package renewal.
To reflect the most recent change in the
form number/year.
Remove Form Expiration Date: 8/31/2022
Changed form number 276-19 to “276-22”.
Page 1 of 1
| File Type | application/pdf |
| File Title | Issue # |
| Author | CMS |
| File Modified | 2022-01-19 |
| File Created | 2022-01-10 |