Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
IHS-912-1, Request for Restriction(s) Unchanged 214 36 0 Form and Instruction 912-1
IHS- 913, Request for Accounting of Disclosures Unchanged 39 7 0 Form and Instruction 913
IHS- 917, Request for Correction/Amendment of Protected Health Information Unchanged 54 9 0 Form and Instruction 917
IHS-810, Authorization for Use or Disclosure of Protected Health Information Unchanged 210954 35159 0 Form and Instruction IHS 810
IHS-912-2, Request for Revocation of Restriction(s) Unchanged 3 1 0 Form and Instruction 912-2
Total burden requested under this ICR: 211264 35212 0  
To view an IC, click on IC Title