Information Collection

Corrective Action Plan and Monitoring

IC 239116 under ICR 201912-0938-024 · OMB 0938-1390.

⚠️ Notice: This information collection may be referencing outdated material.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 Corrective Action Plan and Monitoring Form and Instruction
CMS-10662 Notice_of_Corrective_Action_508 CMS-10662_Notice_of_Corrective_Action_508.pdf Form and Instruction
CMS-10662 Corrective_Action_Followup_Letter_508 CMS-10662_Corrective_Action_Followup_Letter_508.pdf Form and Instruction
CMS-10662_Notice_of_Corrective_Action_Closure_508.pdf Notice_of_Corrective_Action_Closure_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Failure_to_Comply_508.pdf Notice_of_Corrective_Action_Failure_to_Comply_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Re-Assessment_508.pdf Notice_of_Corrective_Action_Re-Assessment_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508.pdf Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Corrective Action Plan and Monitoring	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	Notice_of_Corrective_Action_508	CMS-10662_Notice_of_Corrective_Action_508.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10662	Corrective_Action_Followup_Letter_508	CMS-10662_Corrective_Action_Followup_Letter_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)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Notice_of_Corrective_Action_Closure_508	CMS-10662_Notice_of_Corrective_Action_Closure_508.pdf	12/30/2019
Notice_of_Corrective_Action_Failure_to_Comply_508	CMS-10662_Notice_of_Corrective_Action_Failure_to_Comply_508.pdf	12/30/2019
Notice_of_Corrective_Action_Re-Assessment_508	CMS-10662_Notice_of_Corrective_Action_Re-Assessment_508.pdf	12/30/2019
Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508	CMS-10662_Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508.pdf	12/30/2019

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