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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:
0945-0002
ICR Reference No:
202209-0945-001
Status:
Active
Previous ICR Reference No:
201906-0945-004
Agency/Subagency:
HHS/OCR
Agency Tracking No:
Title:
Complaint Forms for Civil Rights and Conscience; Health Information Privacy and Security Complaints
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:
12/19/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/31/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2025
36 Months From Approved
12/31/2022
Responses
45,838
0
33,732
Time Burden (Hours)
34,379
0
25,299
Cost Burden (Dollars)
0
0
0
Abstract:
Individuals may file written complaints with the Office for Civil Rights when they believe they have been discriminated against by programs or entities that receive Federal financial assistance from HHS or if they believe that, on or after April 14, 2003, their right to the privacy of protected health information has been violated. The complaint forms in this PRA submission provide the basic information needed by OCR to allow initial processing of such complaints.
Authorizing Statute(s):
US Code:
29 USC 794
Name of Law: Section 504 of the Rehabilitation Act of 1973
US Code:
42 USC 2000d
Name of Law: Title VI of the Civil Rights Act of 1964
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:
87 FR 41732
07/13/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 60177
10/04/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Civil Rights and Conscience Complaint
0945-0002
Civil Rights and Conscience Complaint Form
Health Information Privacy and Security Complaint
0945-0002
Health Information Privacy and Security Complaint
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
45,838
33,732
0
0
12,106
0
Annual Time Burden (Hours)
34,379
25,299
0
0
9,080
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:
No
Burden Reduction Due to:
Short Statement:
The complaint filing process has not changed. However, our volume of complaints has increased since our previous 83-I supporting statement (2009). Increased outreach and expanded responsibilities likely have contributed to the increase in the number of complaints. This increased number is based on the number of complaints documented in the electronic recordkeeping system of OCR, known as the Program Information Management System (PIMS). Consequently, while the burden per complaint remains unchanged at 45 minutes, an adjustment in total burden has increased from to 25,299 hours to 34,379 hours due to the increase of respondents which reflects an increase in burden hours.
Annual Cost to Federal Government:
$7,561
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
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?
No
Agency Contact:
Donna Householder 202 774-3014 donna.householder@hhs.gov
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:
10/31/2022
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