OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Compliance Review

IC 239115 under ICR 202506-0938-005 · OMB 0938-1390.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Compliance Review
 
No Modified
 
Mandatory
 
45 CFR 160.310 45 CFR 160.308

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10662 Operating_Rule_Response_Attestation ASHEPS_Operating_Rule_Response_Attestation_2024_FINAL_CLEAN.docx Yes Yes Fillable Printable
Form and Instruction CMS-10662 Compliance_Review_Package ASHEPS_Compliance_Review_Package_2024_FINAL_CLEAN.docx Yes Yes Fillable Printable
Form and Instruction CMS-10662 Compliance Review Program Triage Questionnaire Clearinghouses ASETT_Compliance_Review_Triage_Questionnare_CLH_2024_FINAL.docx Yes Yes Fillable Printable
Form and Instruction CMS-10662 Compliance Review Program Triage Questionnaire Health Plans ASETT_Compliance_Review_Triage_Questionnare_HPL_2024_FINAL.docx Yes Yes Fillable Printable
Form and Instruction CMS-10662 Compliance Review Program Triage Questionnaire Providers ASETT_Compliance_Review_Triage_Questionnare_PRO_2024_FINAL.docx Yes Yes Fillable Printable

Health Health Care Services

 

100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 50 0 0 50
Annual IC Time Burden (Hours) 1,000 0 500 0 0 500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - Operating_Rule_Response_Attestation ASETT_cms 10662_Operating_Rule_Response_Attestation_FINAL_2024_Track_Changes.docx 06/06/2025
Track Change - Compliance_Review_Package ASETT_CMS 10662_ Notice of Compliance Review_2023_FINAL_Track_Changes.docx 06/06/2025
Assessment_Draft_Findings_Report ASETT_Notice_of_Draft_Findings_2024_FINAL.docx 06/06/2025
Notice of Compliance Review Closure ASETT_Notice_of_Compliance_Review_Closure_CA_Completed_2024_FINAL.docx 06/06/2025
Notice_of_CR_Closure_No_Violations ASETT_Notice_of_CR_Closure_No_Violations_2024_FINAL.docx 06/06/2025
Follow_Up_Request_For_Information ASETT_Follow_Up_Request_For_Information_Letter_2024_FINAL.docx 06/06/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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