Compliance Review

Administrative Simplification HIPAA Compliance Review (CMS-10662)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1390 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10662 Compliance Review Form and Instruction
CMS-10662 ASETT_Assessment_All_Operating_Rule_Response_Attestation CMS-10662_ASETT_Assessment_All_Operating_Rule_Response_Attestation_v_1.2_Final_508.pdf Form and Instruction
CMS-10662 ASETT_Assessment_Combined_Assessment_Package_Docs_v_1.2_ CMS-10662_ASETT_Assessment_Combined_Assessment_Package_Docs_v_1.2_Final_508.pdf Form and Instruction
CMS-10662_ASETT_Assessment_Follow_Up_Request_For_Information_Letter_v_1.1_Final_508.pdf ASETT_Assessment_Follow_Up_Request_For_Information_Letter_v_1.1_Final_508.pdf IC Document
CMS-10662_ASETT_Assessment_Final_Assessment_Report_v_1.1_Final_508.pdf ASETT_Assessment_Final_Assessment_Report_v_1.1_Final_508 IC Document
CMS-10662_ASETT_Assessment_Draft_Findings_Report_v_1.1_Final_508.pdf ASETT_Assessment_Draft_Findings_Report_v_1.1_Final_508 IC Document

Information Collection (IC) Details

IC Title:	Compliance Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 160.310 45 CFR 160.308

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10662	ASETT_Assessment_Combined_Assessment_Package_Docs_v_1.2_Final_508	CMS-10662_ASETT_Assessment_Combined_Assessment_Package_Docs_v_1.2_Final_508.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10662	ASETT_Assessment_All_Operating_Rule_Response_Attestation_v_1.2_Final_508	CMS-10662_ASETT_Assessment_All_Operating_Rule_Response_Attestation_v_1.2_Final_508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ASETT_Assessment_Follow_Up_Request_For_Information_Letter_v_1.1_Final_508.pdf	CMS-10662_ASETT_Assessment_Follow_Up_Request_For_Information_Letter_v_1.1_Final_508.pdf	12/30/2019
ASETT_Assessment_Final_Assessment_Report_v_1.1_Final_508	CMS-10662_ASETT_Assessment_Final_Assessment_Report_v_1.1_Final_508.pdf	12/30/2019
ASETT_Assessment_Draft_Findings_Report_v_1.1_Final_508	CMS-10662_ASETT_Assessment_Draft_Findings_Report_v_1.1_Final_508.pdf	12/30/2019

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