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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

202206-0938-024 Approved without change	Extension without change of a currently approved collection	2022-06-29
201903-0938-008 Approved with change	New collection (Request for a new OMB Control Number)	2019-03-15