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pdfRevisions Crosswalk (Form 276-25)
4th Quarter Interim Cost Report
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 D
Row 73
4.
Worksheet D
Row 147
5.
Worksheet D
Row 223
6.
Worksheet D
Row 303
Action to be
performed
Change form
number
Remove
Change form
number
Change form
number
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 name and number HCFA 27622 to “CMS 276-25”.
Changed form name and number HCFA 27622 to “CMS 276-25”.
Changed form name and number HCFA 27622 to “CMS 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.
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 Type | application/pdf |
File Title | 4th Quarter Interim Cost Report Crosswalk |
Subject | 4th Quarter Interim Cost Report Crosswalk |
Author | CMS |
File Modified | 2025-01-22 |
File Created | 2025-01-22 |