OMB control number
Home and Community Based Services (HCBS) Incident Management Survey (CMS-10692)
OMB 0938-1362 · HHS/CMS.
OMB 0938-1362
States will be requested to complete and submit the survey which is intended to identify methods and promising practices for identifying, reporting, tracking, and resolving incidents of abuse, neglect, and exploitation. The results of the survey will also be used to review the strengths and weaknesses of each state’s incident management system and will inform guidance to help ensure states comply with sections 1902(a)(30)(A) and 1915(c)(2)(A) of the Social Security Act.
The latest form for Home and Community Based Services (HCBS) Incident Management Survey (CMS-10692) expires 2026-04-30 and is listed under ICR 202206-0938-024.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 CMS-10692. IM Survey - Public Comment Response June 2022.docx | Supplementary Document |
| CMS-10692 - Supporting Statement B.docx | Supporting Statement B |
| CMS-10692 - Supporting Statement A.docx | Supporting Statement A |
 HCBS Incident Management Survey |
Other-Introductory Email |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202206-0938-024 | Extension without change of a currently approved collection | 2022-06-29 | Approved without change | |
| 201903-0938-008 | New collection (Request for a new OMB Control Number) | 2019-03-15 | Approved with change |