HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form (CMS-10148)

This revised collection of information modifies the current form to remove the HIPAA Privacy/Security complaint category section. The section is revised to read as follows: “Identify the HIPAA Non-Privacy/Security complaint category” section of the complaint form. On this revised version of the form, complainants are given an opportunity to check the “Unique Identifiers” and “Operating Rules” option to additionally categorize the type of HIPAA complaint being filed. The revised form also requests an email address for filed against entities, if available. Finally, the revised form is structured so that it be expanded to collect additional HIPAA Administrative Simplification complaint types in the future.

The latest form for HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form (CMS-10148) expires 2029-04-30 and is listed under ICR 202606-0938-005.