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Get Roster Matrix Form Cms 672 2020-2025
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How to fill out the Roster Matrix Form Cms 672 online
Filling out the Roster Matrix Form Cms 672 online is a straightforward process that involves completing several essential sections. This guide provides clear instructions to help you accurately complete the form with ease.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to access the form and open it in your chosen editor.
- In Part A, enter the personal data of the individual receiving the award, including sections like 'To', 'From', 'Branch of Service', 'Recommended Award', 'Reason', and 'Period of Award'. Ensure that each section is filled out completely.
- For section 10a, input the individual's name. Fill in their rank, duty position/title, organization, and social security number in the respective fields.
- Indicate any previous awards received in section 13, ensuring accuracy in the information provided.
- In the recommender section, fill out the name, title/position, and address of the individual recommending the award. A signature and rank are also required.
- Part B requires justification for the award. Use section 20a to provide detailed information and include additional sheets if necessary.
- Complete section 21 by certifying the individual's eligibility and signing the certification. Ensure to include the date.
- In the approval authority section, fill out the required fields regarding approval or disapproval, including name, title, and signature.
- Part C covers orders data; include the orders issuing headquarters, order number, approved award, and details about the orders approval authority.
- Once you have completed all sections, save your changes and choose to download, print, or share the form as required.
Complete the Roster Matrix Form Cms 672 online today to ensure all necessary details are properly submitted.
The Roster/Sample Matrix form (CMS-802 ) is used by the facility to list all current residents (including residents on bedhold) and to note pertinent care categories.
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