OMB control number

Administrative Simplification HIPAA Compliance Review (CMS-10662)

OMB 0938-1390 · HHS/CMS.

OMB 0938-1390

The purpose of this collection is to retrieve information necessary to conduct a compliance review as described in CMS-0014-N (68 FR 60694). These forms will be submitted to the Centers for Medicare & Medicaid Services (CMS), Program Management National Standards Group, from entities covered by HIPAA Administrative Simplification regulations. It is expected that covered entities under HIPAA (health plans, health care clearinghouses, and health care providers who electronically transmit any health information in connection with transaction for which HHS has adopted standards) will complete these forms during a CMS scheduled compliance review. CMS enforcement staff would use the information provided by covered entities to review HIPAA Administrative Simplification compliance in regards to adopted transaction standards, code sets, unique identifiers and operating rules.

The latest form for Administrative Simplification HIPAA Compliance Review (CMS-10662) expires 2029-03-31 and is listed under ICR 202506-0938-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10662 Corrective Action Follow-up Letter	Form and Instruction
Form CMS-10662 Notice_of_Corrective_Action_	Form and Instruction
Form CMS-10662 Structuring and monitoring the CAP	Form and Instruction
Form CMS-10662 Compliance Review Program Triage Questionnaire Providers	Form and Instruction
Form CMS-10662 Compliance Review Program Triage Questionnaire Health Plans	Form and Instruction
Form CMS-10662 Compliance Review Program Triage Questionnaire Clearinghouses	Form and Instruction
Form CMS-10662 Compliance_Review_Package	Form and Instruction
Form CMS-10662 Operating_Rule_Response_Attestation	Form and Instruction
Form CMS-10662 Compliance Review	Form and Instruction
CMS-10662_Supporting_Statement_Part_A.docx	Supporting Statement A
CMS-10662_Supporting_Statement_Part_A.docx	Supporting Statement A
New York Urology Specialists.pdf	Public Comments
CMS-10662_Response to Public Comments.docx	Supplementary Document
CMS-10662_Response to Public Comments.docx	Supplementary Document
ASHEPS_Compliance_Review_Exhibit_A_Crosswalk_2024_FINAL.pdf	Supplementary Document
ASHEPS_Compliance_Review_Exhibit_A_Crosswalk_2024_FINAL.pdf	Supplementary Document
Structuring and monitoring the CAP	Form and Instruction
Structuring and monitoring the CAP	Form and Instruction
Structuring and monitoring the CAP	Form and Instruction
Compliance Review	Form and Instruction
Compliance Review	Form and Instruction
Compliance Review	Form and Instruction
Compliance Review	Form and Instruction
Compliance Review	Form and Instruction
Compliance Review	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202506-0938-005	Revision of a currently approved collection	2025-06-18
202402-0938-003	Revision of a currently approved collection	2024-02-20	Approved with change
201912-0938-024	New collection (Request for a new OMB Control Number)	2019-12-30	Approved with change

OMB Details

Compliance Review

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10662	Compliance_Review_Package	Fillable Printable	Form and instruction
Form CMS-10662	Compliance Review Program Triage Questionnaire Providers	Fillable Printable	Form and instruction
Form CMS-10662	Compliance Review Program Triage Questionnaire Health Plans	Fillable Printable	Form and instruction
Form CMS-10662	Compliance Review Program Triage Questionnaire Clearinghouses	Fillable Printable	Form and instruction
Form CMS-10662	Operating_Rule_Response_Attestation	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.