Document Name Document Type
Form CMS-10662 Corrective Action Plan and Monitoring Form and Instruction
CMS-10662 Notice_of_Corrective_Action_508 ASETT_Notice_of_Corrective_Action_.pdf Form and Instruction
CMS-10662 Notice_of_Corrective_Action_508 ASETT_Notice_of_Corrective_Action_.pdf Form and Instruction
CMS-10662 Corrective_Action_Followup_Letter_508 CMS-10662_Corrective Action Follow up Letter_508_2023.pdf Form and Instruction
CMS-10662 Corrective_Action_Followup_Letter_508 CMS-10662_Corrective Action Follow up Letter_508_2023.pdf Form and Instruction
CMS-10662_Notice_of_Corrective_Action_Closure_508_2023.pdf Notice_of_Corrective_Action_Closure_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Closure_508_2023.pdf Notice_of_Corrective_Action_Closure_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Failure_to_Comply_508_2023.pdf Notice_of_Corrective_Action_Failure_to_Comply_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Failure_to_Comply_508_2023.pdf Notice_of_Corrective_Action_Failure_to_Comply_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Re-Assessment_508_2023.pdf Notice_of_Corrective_Action_Re-Assessment_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Re-Assessment_508_2023.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_2023.pdf Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508 IC Document
CMS-10662_Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508_2023.pdf Notice_of_Corrective_Action_Select_One_Mitigating_Factors_Affirmative_Defenses_Waiver_Support_Approval_508 IC Document

Information Collection (IC) Details

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IC Title:	Corrective Action Plan and Monitoring	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 160.308 45 CFR 160.310

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	ASETT_Notice_of_Corrective_Action_.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10662	Corrective_Action_Followup_Letter_508	CMS-10662_Corrective Action Follow up Letter_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: 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 %

	Approved	Previously Approved
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_2023.pdf	02/08/2024
Notice_of_Corrective_Action_Failure_to_Comply_508	CMS-10662_Notice_of_Corrective_Action_Failure_to_Comply_508_2023.pdf	02/08/2024
Notice_of_Corrective_Action_Re-Assessment_508	CMS-10662_Notice_of_Corrective_Action_Re-Assessment_508_2023.pdf	02/08/2024
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_2023.pdf	02/08/2024

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

Corrective Action Plan and Monitoring

Administrative Simplification HIPAA Compliance Review (CMS-10662)

OMB: 0938-1390

IC ID: 239116

View Information Collection (IC)