Survey Report Documentation and Data Entry

6136.4 - Survey Report Documentation and Data Entry (Rev. 230; Issued: 07-11-25; Effective: 07-11-25; Implementation: 07-11-25) Following the survey, enter into the CLIA Data System any revisions, additions, or deletions to the application (Form CMS-116) information. Refer to the CLIA Systems Users Guide for specific information and instruction. Enter into the data system the Certification Kit, which consists of: • Form CMS-1539, Certification and Transmittal; • Form CMS-2567, Statement of Deficiencies and Plan of Correction; and • Form CMS-670, Survey Team Composition and Workload Report (see section 6428).