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PRINTED: 09/29/2021
FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION
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What is extension of form flexibility?
Extension of form flexibility allows for additional time to submit required forms.
Who is required to file extension of form flexibility?
Any individual or entity who needs more time to complete and submit forms.
How to fill out extension of form flexibility?
Fill out the necessary extension request form and submit it to the appropriate authority.
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The purpose is to provide individuals or entities with extra time to fulfill their reporting requirements.
What information must be reported on extension of form flexibility?
The reason for the extension request and the anticipated date of form submission.
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