This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. Check the official instructions before completing and submitting the form.
Q: What is the DHCS3076 form?
A: The DHCS3076 form is a cost report for Intermediate Care Facilities for the Developmentally Disabled Habilitative/Nursing (ICF-DDH/N) in California.
Q: Who is required to complete the DHCS3076 form?
A: Intermediate Care Facilities for the Developmentally Disabled Habilitative/Nursing (ICF-DDH/N) in California are required to complete the DHCS3076 form.
Q: What is the purpose of the DHCS3076 form?
A: The purpose of the DHCS3076 form is to report the costs and expenses incurred by Intermediate Care Facilities for the Developmentally Disabled Habilitative/Nursing (ICF-DDH/N) in California.
Q: What information is included in the DHCS3076 form?
A: The DHCS3076 form includes information about the facility's revenues, expenses, patient days, staffing, and other related data.
Q: When is the DHCS3076 form due?
A: The due date for submission of the DHCS3076 form is specified by the California Department of Health Care Services (DHCS). Facility operators should adhere to the specified deadline.
Q: Are there any penalties for late submission of the DHCS3076 form?
A: Failure to submit the DHCS3076 form by the specified deadline may result in penalties or sanctions imposed by the California Department of Health Care Services (DHCS).
Form Details:
Download a fillable version of Form DHCS3076 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.