Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
IHS-912-1, Request for Restriction(s) Modified 15000 2500 0 Form and Instruction 0917-0030, IHS-912-1
IHS- 913, Request for Accounting of Disclosures Modified 15000 2500 0 Form and Instruction 0917-0030
IHS- 917, Request for Correction/Amendment of Protected Health Information Modified 7500 1875 0 Form and Instruction 0917-0030, IHS-917
IHS-810, Authorization for Use or Disclosure of Protected Health Information Modified 500000 166667 0 Form and Instruction 0917-0030, IHS-810
IHS-912-2, Request for Revocation of Restriction(s) Modified 5000 833 0 Form and Instruction 0917-0030-IHS-912-2
Total burden requested under this ICR: 542500 174375 0  
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