Information Collection

Compliance Review

IC 239115 under ICR 202402-0938-003 · OMB 0938-1390.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-06-18 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form CMS-10662 Compliance Review Form and Instruction
CMS-10662 ASETT_Assessment_All_Operating_Rule_Response_Attestation ASETT_cms 10662_Operating_Rule_Response_Attestation_FINAL_2023_.pdf Form and Instruction
CMS-10662 ASETT_Assessment_All_Operating_Rule_Response_Attestation ASETT_cms 10662_Operating_Rule_Response_Attestation_FINAL_2023_.pdf Form and Instruction
CMS-10662 ASETT_Notice of Assessment_Package 2023 CMS-10662_Notice of Assessment_Final_508_ 2023.pdf Form and Instruction
CMS-10662 ASETT_Notice of Assessment_Package 2023 CMS-10662_Notice of Assessment_Final_508_ 2023.pdf Form and Instruction
CMS-10662_ASETT_Assessment_Follow Up Request_For_Information_Letter_Final_508_2023.pdf ASETT_Assessment_Follow_Up_Request_For_Information_Letter_ IC Document
CMS-10662_ASETT_Assessment_Follow Up Request_For_Information_Letter_Final_508_2023.pdf ASETT_Assessment_Follow_Up_Request_For_Information_Letter_ IC Document
CMS-10662_ASETT_Assessment_Notice of Final_Assessment _Final_508_2023.pdf ASETT_Assessment_Final_Assessment_Report_ IC Document
CMS-10662_ASETT_Assessment_Notice of Final_Assessment _Final_508_2023.pdf ASETT_Assessment_Final_Assessment_Report_ IC Document
CMS-10662_ASETT_Assessment_Notice of Draft Findings_Report_Final_508_2023.pdf ASETT_Assessment_Draft_Findings_Report IC Document
CMS-10662_ASETT_Assessment_Notice of Draft Findings_Report_Final_508_2023.pdf ASETT_Assessment_Draft_Findings_Report IC Document
ASETT_CMS 10662_ Notice of Compliance Review_2023_FINAL.pdf Notice of Compliance Review IC Document
ASETT_CMS 10662_ Notice of Compliance Review_2023_FINAL.pdf Notice of Compliance Review IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Compliance Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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_All_Operating_Rule_Response_Attestation	ASETT_cms 10662_Operating_Rule_Response_Attestation_FINAL_2023_.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10662	ASETT_Notice of Assessment_Package	2023 CMS-10662_Notice of Assessment_Final_508_ 2023.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	40	10
Annual IC Time Burden (Hours)	500	400	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ASETT_Assessment_Follow_Up_Request_For_Information_Letter_	CMS-10662_ASETT_Assessment_Follow Up Request_For_Information_Letter_Final_508_2023.pdf	02/08/2024
ASETT_Assessment_Final_Assessment_Report_	CMS-10662_ASETT_Assessment_Notice of Final_Assessment _Final_508_2023.pdf	02/08/2024
ASETT_Assessment_Draft_Findings_Report	CMS-10662_ASETT_Assessment_Notice of Draft Findings_Report_Final_508_2023.pdf	02/08/2024
Notice of Compliance Review	ASETT_CMS 10662_ Notice of Compliance Review_2023_FINAL.pdf	02/08/2024

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