Preparation of the State Survey Agency Certification Workload

4627 - Preparation of the State Survey Agency Certification Workload Report - Form CMS-434 (Exhibit 52) (Rev. 1, 05-21-04) The SA is required to prepare a planned workload report to accompany its budget request for survey and certification activity. The SA: A. Column (A), Facility Counts Enters the projected number of facilities at the start of the FY for each facility type listed under column titled Type of Provider. B. Column (B), Initial Visits Enters for projected facility type, the number of visits for initial certification surveys. C. Column (C), Resurvey Visits Enters for projected facility type, the number of visits for recertification surveys. D. Column (D), Follow-Up Visits Enters for projected facility type, the number of visits that the SA makes as a result of finding deficiencies in initial, resurvey, and complaint visits to providers. E. Column (E), Complaint Visits Enters for each facility type, the number of visits the SA makes to investigate complaints from beneficiaries, facility staff, etc. F. Column (F), Total Visits The automated system totals each facility type, the cumulative number for items, columns B through E. G. Certification Form CMS-434 must be certified by an appropriate SA official by typing their name and title in the appropriate space.