View Information Collection Request (ICR) Package

OMB Control No: 0917-0030	ICR Reference No: 201603-0917-001
Status: Historical Active	Previous ICR Reference No: 201301-0917-002
Agency/Subagency: HHS/IHS	Agency Tracking No: 0917-0030
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 with change	Conclusion Date: 08/30/2016
	Date Received in OIRA: 03/28/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	211,264	0	542,500
Time Burden (Hours)	35,212	0	174,375
Cost Burden (Dollars)	0	0	0

Abstract: This is a request for an extension without a revision of a previously approved collection which is due to expire April 30, 2016. This collection of information is made necessary by the Department of Health and Human Services Rule entitled Standards for Privacy of Individually Identifiable Health Information (A Privacy Rule) (45 CFR Parts 160 and 164). The Privacy Rule implements the privacy requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 and creates national standards that protect patient health information and gives our patients access to their health information.

Authorizing Statute(s): PL: Pub.L. 104 - 191 264 Name of Law: Health Insurance Portability and Accountability Act

Citations for New Statutory Requirements: None

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:
	81 FR 3806	01/22/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 15347	03/22/2016
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	211,264	542,500	-331,236
Annual Time Burden (Hours)	35,212	174,375	-139,163
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There are no program changes or adjustments. There was a change in IHS-810 Form to include an option for the respondents to release information to Health Information Exchanges. This change is due to the technology solution to share patient information electronically in order to meet Meaningful Use Stage 2 with the IHS’s certified electronic health record, as required by 42 C.F.R. Parts 412, 413, and 495. The program also made a discretionary change in the burden hours; decreasing the burden hours on two forms, the IHS-810 and IHS-917, from 20 minutes to 10 minutes to more accurately reflect the actual time it takes to complete the form(s). Additionally, the number of respondents were decreased for all five forms to reflect actual baseline numbers collected and provided by the Area Health Information Managers (HIMs). Also, in the table under 12B., “estimated annual costs to respondents for this collection,” the hourly wage rate for respondents was changed from $19 per hour to $17 per hour to more accurately reflect the actual wages of American Indians and Alaska Natives (AIAN). The average annual income of American Indians was $36,252 and the poverty rate was 29%, in 2014 (United States Census Bureau, 2015) (See US Census webpage, “Facts for Features: American Indian and Alaska Native Heritage Month: November 2014” at http://www.census.gov/newsroom/facts-for-features/2014/cb14-ff26.html). Further, the average annual income for AIANs may even be lower as the United States Bureau of Labor Statistics (BLS) reported a 54% population-employment ratio for AIANs, with an 11.3% average unemployment rate. (See BLS report “Labor Force Statistics by Race and Ethnicity, 2014” at http://www.bls.gov/opub/reports/cps/labor-force-characteristics-by-race-and-ethnicity-2014.pdf).

Annual Cost to Federal Government: $1,020,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Sandra Maclin 301 443-6306 sandra.maclin@ihs.gov

View ICR - OIRA Conclusion