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Region IV Emergency Response Civil Money Penalty funds application CMP funds 2026
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- Click ‘Get Form’ to open the Region IV Emergency Response CMP application in the editor.
- Begin by filling out the Nursing Home Background Information section. Enter the date of application, facility name, address, and contact details accurately.
- In the Nursing Home Survey History section, provide dates of last surveys and any outstanding civil money penalty amounts. This information is crucial for your application.
- Describe the emergent event in detail under the Emergent Event section. Include dates, number of residents affected, and type of emergency.
- Select the funding category that corresponds to your request amount. Ensure you understand prohibited uses of CMP funds as outlined in the form.
- Complete the Attestation Statement at the end of the application. Ensure all required signatures are obtained from relevant parties before submission.
- Assemble all documentation into a single PDF file using Times New Roman font, size 12 for appendices, and submit electronically to your State Survey Agency.
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Related links
Nov 11, 2013 In determining whether a financial penalty or other remedy is appropriate, the City shall not impose a penalty if the project applicant/sponsor
May 7, 2019 A CMP is a monetary penalty the Centers for Medicare Medicaid. Region IV/Atlanta Emergency Response CMP Application. CMP Projects $470,263.09