Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
500 or More Affected Individuals (investigating and documenting breach) Unchanged 5 267 0
Accounting of Disclosures - Training Unchanged 16066 8033 0
Accounting of Disclosures of Part 2 Records Unchanged 100 5 0
Attach consent form with each disclosure (electronic records) Unchanged 5033790 41948 0
Attach consent form with each disclosure (paper records) Unchanged 559311 46609 0
Breach Notification - Training Unchanged 16066 16066 0
Complaint Procedures & Nonretaliation- Training Unchanged 16066 12050 0
Disclosures for Audit & Evaluation - Electronic Unchanged 125845 10487 0
Disclosures for Audit & Evaluation - Paper Unchanged 13983 3496 0
Disclosures for Research - Electronic Unchanged 125845 10487 0
Disclosures for Research - Paper Unchanged 13983 3496 0
Documenting Emergency Treatment Disclosures Unchanged 32132 5355 0
Individual Breach Notice-Substitute Notice (posting or publishing) Unchanged 55 55 0
Individual Breach Notice-Written and E-mail Notice (drafting) Unchanged 1170 585 0
Individual Breach Notice-Written and E-mail Notice (preparing and documenting) Unchanged 1170 585 0
Individual Breach Notice-Written and E-mail Notice (processing and sending) Unchanged 2270271 18162 0
Individual Notice-Substitute Notice (individuals' voluntary burden to call toll-free number for information) Unchanged 2265 283 0
Individual Notice-Substitute Notice (staffing toll-free number) Unchanged 55 188 0
Less than 500 Affected Individuals (investigating and documenting breach) -- affecting 10-499 Unchanged 50 400 0
Less than 500 Affected Individuals (investigating and documenting breach) -- affecting <10 Unchanged 1115 4460 0
Media Notice - Breach Unchanged 5 6 0
Notice to Accompany Disclosure - Updating Unchanged 16066 5355 0
Notice to Secretary (notice for breaches affecting 500 or more individuals) Unchanged 5 6 0
Notice to Secretary (notice for breaches affecting fewer than 500 individuals) Unchanged 1164 1164 0
Obtaining Consent - Training Unchanged 32132 16066 0
Obtaining Consent for TPO Unchanged 1864367 155364 0
PDMP Reporting Unchanged 2828050 94268 0
Patient Notice - Providing to Patient Unchanged 1864367 38841 0
Patient Notice - Updating Unchanged 16066 16066 0
Patient Notice and Right to Discuss - Training Unchanged 224231 56058 0
Programs Receiving a Complaint Unchanged 1864 311 0
Reports to the Secretary Unchanged 506 759 0
Requests for Restrictions - Training Unchanged 48198 12050 0
Right to Discuss Patient Notice Unchanged 18644 2175 0
Right to Request Restrictions Unchanged 1200 120 0
Training Program Development Unchanged 16066 80330 0
Updating Consent Form Unchanged 16066 10711 0
Total burden requested under this ICR: 15178340 672667 0  
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