Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
500 or More Affected Individuals (investigating and documenting breach) New 5 250 0
Accounting of Disclosures - Training New 16066 8033 0
Accounting of Disclosures of Part 2 Records New 100 5 0
Breach Notification - Training New 16066 16066 0
Complaint Procedures & Nonretaliation- Training New 16066 12050 0
Disclosures for Audit & Evaluation - Electronic New 125845 10487 0
Disclosures for Audit & Evaluation - Paper New 13983 3496 0
Disclosures for Research - Electronic New 125845 10487 0
Disclosures for Research - Paper New 13983 3496 0
Documenting Emergency Treatment Disclosures New 32132 5355 0
Individual Breach Notice-Substitute Notice (posting or publishing) New 55 55 0
Individual Breach Notice-Written and E-mail Notice (drafting) New 1170 585 0
Individual Breach Notice-Written and E-mail Notice (preparing and documenting) New 1170 585 0
Individual Breach Notice-Written and E-mail Notice (processing and sending) New 2270970 18168 0
Individual Notice-Substitute Notice (individuals' voluntary burden to call toll-free number for information) New 2265 283 0
Individual Notice-Substitute Notice (staffing toll-free number) New 55 188 0
Less than 500 Affected Individuals (investigating and documenting breach) -- affecting 10-499 New 50 400 0
Less than 500 Affected Individuals (investigating and documenting breach) -- affecting <10 New 1115 4460 0
Media Notice - Breach New 5 6 0
Notice to Accompany Disclosure - Updating New 16066 5355 0
Notice to Secretary (notice for breaches affecting 500 or more individuals) New 5 6 0
Notice to Secretary (notice for breaches affecting fewer than 500 individuals) New 1164 1164 0
Obtaining Consent - Training New 32132 16066 0
Obtaining Consent for TPO New 1864367 155364 0
PDMP Reporting New 2828050 94268 0
Patient Notice - Providing to Patient New 1864367 38841 0
Patient Notice - Updating New 16066 16066 0
Patient Notice and Right to Discuss - Training New 202072 50518 0
Reports to the Secretary New 225 338 0
Requests for Restrictions - Training New 48198 12050 0
Right to Discuss Patient Notice New 18644 2175 0
Right to Request Restrictions New 800 40 0
Training Program Development New 16066 80330 0
Updating Consent Form New 16066 10711 0
Total burden requested under this ICR: 9561234 577747 0  
To view an IC, click on IC Title