Form Cms-3070i - Individual Observation Worksheet Page 2

Download a blank fillable Form Cms-3070i - Individual Observation Worksheet in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Cms-3070i - Individual Observation Worksheet with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

COLUMN 1 — TIME

COLUMN 2 — OBSERVATION

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control

number. The valid OMB control number for this information collection is 0938-0062. The time required to complete this information collection is estimated to

average 3 hours per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and

review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please

write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

Form CMS-3070I (10/95)