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View ICR - OIRA Conclusion

OMB Control No: 0917-0030	ICR Reference No: 202309-0917-001
Status: Active	Previous ICR Reference No: 201908-0917-001
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: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2023
	Date Received in OIRA: 09/21/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	36 Months From Approved	12/31/2023
Responses	211,517	0	211,264
Time Burden (Hours)	35,255	0	35,212
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	211,517	211,264	253
Annual Time Burden (Hours)	35,255	35,212	43
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: No

Burden Reduction Due to:

Short Statement: The Privacy program has included two new forms to accommodate programmatic changes, and to account for changes in patient services and communication methods over the last few years. The slight burden increase was to accommodate two new forms, which increased burden hours to accommodate both forms.

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

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: Evonne Bennett-Barnes 301 443-4750 evonne.bennett-barnes@ihs.gov

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