N.Y. Comp. Codes R. & Regs. tit. 10, § 412.1 – Facility-supplied information required.

(a) As a part of the inspection process, each residential health care facility operating under the provisions of article 28 of the Public Health Law shall complete and file a report with the appropriate area office of the New York State Department of Health, Office of Health Systems Management. Such report shall be in a form as prescribed by the commissioner and may include, but not be limited to, a reporting of information concerning the facility in the following areas:
1. (1) administration and management;
2. (2) staffing;
3. (3) structure and functions of facility committees;
4. (4) facility policies and procedures; and
5. (5) physical environment.
(b) The report shall indicate the appropriate area office of the New York State Department of Health, Office of Health Systems Management, to which the report shall be returned. A facility possessing operating certificates to provide both nursing home and health-related services may submit one such report to the appropriate area office.
(c) Each residential health care facility shall complete and file such form within 30 days of receipt of the report. An extension of time for filing such report may be granted upon application received by the appropriate area office prior to the due date of the report, and only in those circumstances where the residential health care facility establishes, by documentary evidence, that the report cannot be filed by the due date for reasons beyond the control of the facility.
(d) In the event that any information or data which a residential health care facility has submitted in this report is inaccurate or incorrect, whether by reason of subsequent events or otherwise, such facility shall correct such information or data. Such correction may be made by submitting to the appropriate area office of the New York State Department of Health, Office of Health Systems Management, the accurate information or data on a form which meets the same certification requirements as the report being corrected, or the facility may correct such information or data at the time of the inspection.