View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Compliance Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 160.310 45 CFR 160.308

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10662				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10662				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	50	0	0	40	0	10
Annual IC Time Burden (Hours)	500	0	0	400	0	100
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ASETT_Assessment_Follow_Up_Request_For_Information_Letter_		02/08/2024
ASETT_Assessment_Final_Assessment_Report_		02/08/2024
ASETT_Assessment_Draft_Findings_Report		02/08/2024
Notice of Compliance Review		02/08/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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