March, 2003

Information Bulletin 03-4

Staffing and Census Data for Certified Nursing Homes
Clarification of Instructions for Forms Completion


CMS has found that some facilities are erroneously providing staffing information on the form CMS-671 based on the entire building, not just the certified facility. Since staffing and resident data are now being presented to the public as an indication of staffing level, the facilities that are completing the staffing fields incorrectly on the form CMS-671 are being shown with inflated staffing levels instead of the true level.


The purpose of this information bulletin is to inform Certified Nursing Homes that the data fields on the CMS forms 671 and 672, provided to nursing homes during a standard federal certification survey, need to be completed accurately and the forms will now contain additional information to facilitate accurate completion. The information provided to State Survey Agencies regarding the implementation for the completion of these forms is available to nursing homes at: [expired link]

Information concerning staffing and number of residents is included on these forms. The data fields for staffing and numbers of residents on both of these forms are to be completed by facilities using totals from the certified facility only and not the entire building, if part of the building is not certified.

Effective Date: February 13, 2003

If you have any questions regarding this Information Bulletin, please contact in writing:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4101

Friday, February 06, 2015 at 02:52PM