Information Collection

Deemed Compliance Reporting

IC 201038 under ICR 201208-0938-006 · OMB 0938-1146.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1146 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10407 Deemed Compliance Reporting	Form and Instruction
CMS-10407 Deliberative Document CMS-10407.Deliberative Document.docx	Form and Instruction

IC Title:

Deemed Compliance Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.200(a)(4)(iii)(C)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10407	Deliberative Document	CMS-10407.Deliberative Document.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 220

Number of Respondents for Small Entity: 28

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	58,000	58,000
Annual IC Time Burden (Hours)	220	220
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.