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COMMONWEALTH OF VIRGINIA DEPARTMENT OF HUMAN RESOURCE MANAGEMENT

Group Administrator Memo

#07-02

To: From:

Date:

TLC Group Benefits Administrators

Department of Human Resource Management State and Local Health Benefits Programs May 25, 2007

Re:

Completion of the Group Health Plan Report for the IRS/SSA/CMS Data Match Project

Following is information to assist you in completing the Data Match Project report if requested by The Centers for Medicare & Medicaid Services (CMS) and will supersede responses provided in our Group Administrator Memo #05-03 dated July 21, 2005. Thank you for your patience as we have worked through the report’s new format.

Part I: Employer Information

1a

Yes

1b

No

2

As Appropriate

3

No

4

As Appropriate

5

No

Question

Your Response

1

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