Manual Worksheet S-3 Template for FY 2009 Wage Index

Hospitals and intermediaries are to use this template for manually submitting Worksheet S-3, Parts II and III wage data for cost reporting periods beginning on or after October 1, 2004 and before October 1, 2005 (that is, FY 2005 wage data). This spreadsheet must only be used in circumstances where a hospital is not required to submit a cost report electronically to HCRIS.