Crosswalk: Budget Forecast

F. Budget Forecast Crosswalk 508.pdf

Prepaid Health Plan Cost Report (CMS-276)

Crosswalk: Budget Forecast

OMB: 0938-0165

Document [pdf]
Download: pdf | pdf
Revisions Crosswalk (Form 276-25)
Budget Forecast
Note: In Changes to the Application column, the quoted words are what are to be entered. Example in issue #1 is “276-25”; do not enter the words that
explain the change and that are outside of the quotations.
Issue
#
1.

Page #

Section

Worksheet S

Row 59

2.

Worksheet S

Row 68

3.

Worksheet A

4.

Worksheet B

Row 60 &
Row 110
Row 22

Action to be
performed
Change form
number
Remove
Change form
number
Change form
number

Changes to the Application
Changed form number 276-22 to “276-25”.
Remove Form Expiration Date: 9/30/2025
Changed form number 276-22 to “276-25”.
Changed form number 276-22 to “276-25”.

Reason for the Change
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.
To reflect the most recent change in the
form number/year.

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File Typeapplication/pdf
File TitleBudget Forecast Crosswalk
SubjectBudget Forecast Crosswalk
AuthorCMS
File Modified2025-01-22
File Created2025-01-14

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