Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
IHS-912-1, Request for Restriction(s) Modified 214 36 0 Form and Instruction IHS 912-1
IHS- 913, Request for Accounting of Disclosures Modified 39 7 0 Form and Instruction IHS 913
IHS- 917, Request for Correction/Amendment of Protected Health Information Modified 54 9 0 Form and Instruction IHS- 917
IHS-810, Authorization for Use or Disclosure of Protected Health Information Modified 210954 35159 0 Form and Instruction IHS 810
IHS-912-2, Request for Revocation of Restriction(s) Modified 3 1 0 Form and Instruction IHS 912-2
IHS-963, Request for Confidential Communication by Alternative Means or Alternate Location New 214 36 0 Form and Instruction IHS-963
IHS-982, Acknowledgement of Receipt of the Notice of Privacy Practices Protected Health Information New 39 7 0 Form and Instruction IHS-982
Total burden requested under this ICR: 211517 35255 0  
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