View Information Collection Request (ICR) Package
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Burden
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Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0917-0030
ICR Reference No:
200608-0917-002
Status:
Historical Active
Previous ICR Reference No:
200304-0917-001
Agency/Subagency:
HHS/IHS
Agency Tracking No:
Title:
IHS Forms To Implement The Privacy Rule (45 CFR Parts 160 and 164)
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
11/01/2006
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/28/2006
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2009
36 Months From Approved
10/31/2006
Responses
542,500
0
542,500
Time Burden (Hours)
5,425
0
174,375
Cost Burden (Dollars)
0
0
0
Abstract:
This is a request for a extension of a currently approved collection. This collection of information is made necessary by the DHHS Rule entitled "Standards for Privacy of Individually Identifiable Health Information" ("Privacy Rule") (456 CFR Parts 160 and 164). Considered a covered entity under the Privacy Rule, the IHS is subject to the Rule and must develop and implement methods to meet the information collection requirements contained in the rule.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
Statute at Large: 42 Stat. 1320
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
71 FR 31195
06/01/2006
30-day Notice:
Federal Register Citation:
Citation Date:
71 FR 45834
08/10/2006
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
IHS Forms To Implement The Privacy Rule (45 CFR Parts 160 and 164)
IHS-917, IHS912-1, IHS-810, IHS912-2, IHS-913
Auth. use/disclosure hlth info.
,
Request for Restrictions
,
Request for Revocation of Restr.
,
Req. for an Acct. of Disclosures
,
Request for Correction
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
542,500
542,500
0
0
0
0
Annual Time Burden (Hours)
5,425
174,375
0
-168,950
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Cutting Redundancy
Short Statement:
The burden is less because the forms were mildly edited to ease the burden of each patient. Redundancy was eleminated.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Rouleau Christina 301 443-5938
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
08/28/2006
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