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Ties for Individuals with Intellectual Disabilities LARGE FACILITIES 1. (A) PROVIDER NO. 1. (B) MEDICAID I.D. NO. K1 K2 PART I – Instructions for Completing the Form (CMS 2786W) PART II – Existing Resident Board & Care Occupancies Requirements (NFPA 101, Chapter 33) PART III – New Residential Board & Care Occupancies Requirements (NFPA 101, Chapter 32) PART IV – Building Services (New and Existing Facilities) PART V – Operating Features (New and Existing Facilities) PART VI – Cr.

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