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Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) Date: MARCH 4, 2005CMS Manual System Pub. 10020 Onetime Notification Transmittal 144CHANGE REQUEST 3612 SUBJECT:

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What is change request 3612?

Change request 3612 is a formal document used to make a request for a change in a certain process or system.

Who is required to file change request 3612?

Anyone who wants to propose a change or improvement in the process or system mentioned in change request 3612 is required to file it.

How to fill out change request 3612?

Change request 3612 can be filled out by providing the necessary information and details regarding the proposed change, including the reason for the change, expected outcomes, and any supporting documentation.

What is the purpose of change request 3612?

The purpose of change request 3612 is to formally initiate a request for a change or improvement in a specific process or system.

What information must be reported on change request 3612?

Change request 3612 must include information such as the proposed change or improvement, its impact and benefits, any potential risks, and any required resources or support.

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