PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Form 913
New
15000
2500
0
Form and Instruction
IHS-913
Request for Accounting of Disclosures
Form 917
New
7500
1875
0
Form and Instruction
IHS-917
Request for Correction/Amendment of Protected Health Information
Form IHS-912-1
New
15000
2500
0
Form
IHS-912-1
Request for Restriction(s)
Form IHS-912-2
New
5000
833
0
Form
IHS-912-2
Request for Revocation of Restriction(s)
IHS Form 810
Modified
500000
166667
0
Form and Instruction
IHS-810
Authorization for Use or Disclosure of Protected Health Information
Total burden requested under this ICR:
542500
174375
0
To view an IC, click on IC Title
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