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

This survey form is necessary to ensure ICF/IID provider and client characteristics are available and updated annually for the Federal Government's Automated Survey Processing Environment Suite (ASPEN). The surveyor is required to complete the survey foram at the time of the annual recertification or intial certification survey conducted by the State Survey agency. The team leader for the State Survey team must review and approve the completed form before the completion of the survey. The State Medicaid survey agency is responsible for transferring the 3070H information into ASPEN.

The latest form for ICF/IID Survey Report Form (CMS-3070G-I) and Supporting Regulations expires 2022-06-30 and can be found here.