View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

IHS Forms To Implement The Privacy Rule (45 CFR Parts 160 and 164)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction IHS-810 Yes Yes Fillable Printable
Form and Instruction IHS912-1 Yes Yes Fillable Printable
Form and Instruction IHS912-2 Yes Yes Fillable Printable
Form and Instruction IHS-913 Yes Yes Fillable Printable
Form and Instruction IHS-917 Yes Yes Fillable Printable


 

542,500 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 542,500 0 0 0 0 542,500
Annual IC Time Burden (Hours) 5,425 0 -168,950 0 0 174,375
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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