Information Collection Request

Administrative Simplification HIPAA Compliance Review (CMS-10662)

ICR 202506-0938-005 · OMB 0938-1390 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10662 Corrective Action Follow-up Letter Form and Instruction Modified Available
Form CMS-10662 Notice_of_Corrective_Action_ Form and Instruction Modified Available
Form CMS-10662 Structuring and monitoring the CAP Form and Instruction Modified Repair queued
Form CMS-10662 Compliance Review Program Triage Questionnaire Providers Form and Instruction Modified Available
Form CMS-10662 Compliance Review Program Triage Questionnaire Health Plans Form and Instruction Modified Available
Form CMS-10662 Compliance Review Program Triage Questionnaire Clearinghouses Form and Instruction Modified Available
Form CMS-10662 Compliance_Review_Package Form and Instruction Modified Available
Form CMS-10662 Operating_Rule_Response_Attestation Form and Instruction Modified Available
Form CMS-10662 Compliance Review Form and Instruction Modified Repair queued
CMS-10662_Supporting_Statement_Part_A.docx Supporting Statement A Uploaded 2025-06-11 Available
CMS-10662_Supporting_Statement_Part_A.docx Supporting Statement A Uploaded 2025-06-11 Repair queued
New York Urology Specialists.pdf Public Comments Uploaded 2025-02-14 Available
CMS-10662_Response to Public Comments.docx Supplementary Document Uploaded 2025-06-06 Available
CMS-10662_Response to Public Comments.docx Supplementary Document Uploaded 2025-06-06 Repair queued
ASHEPS_Compliance_Review_Exhibit_A_Crosswalk_2024_FINAL.pdf Supplementary Document Uploaded 2025-06-06 Available
ASHEPS_Compliance_Review_Exhibit_A_Crosswalk_2024_FINAL.pdf Supplementary Document Uploaded 2025-06-06 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
239116 Structuring and monitoring the CAP Form and Instruction ModifiedCorrective Action Follow-up Letter
239116 Structuring and monitoring the CAP Form and Instruction ModifiedNotice_of_Corrective_Action_
239116 Structuring and monitoring the CAP Form and Instruction Modified
239115 Compliance Review Form and Instruction ModifiedCompliance Review Program Triage Questionnaire Providers
239115 Compliance Review Form and Instruction ModifiedCompliance Review Program Triage Questionnaire Health Plans
239115 Compliance Review Form and Instruction ModifiedCompliance Review Program Triage Questionnaire Clearinghouses
239115 Compliance Review Form and Instruction ModifiedCompliance_Review_Package
239115 Compliance Review Form and Instruction ModifiedOperating_Rule_Response_Attestation
239115 Compliance Review Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2029 36 Months From Approved 03/31/2026
140 0 60
3,040 0 1,000
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Compliance Review CMS-10662, CMS-10662, CMS-10662, CMS-10662, CMS-10662 ,   ,   ,   ,  
Structuring and monitoring the CAP CMS-10662, CMS-10662 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 140 60 0 80 0 0
Annual Time Burden (Hours) 3,040 1,000 0 2,040 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No