Information Collection Requirements Referenced in HIPAA for Group Health Plans and Supporting Regulations -- 45 CFR 146.111, 115, 117, 150, 152, 160, 180

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0702 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Information Collection Requirements Referenced in HIPAA for Group Health Plans and Supporting Regulations -- 45 CFR 146.111, 115, 117, 150, 152, 160, 180	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-206				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,430	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	32	-42,499,968	42,500,000
Annual IC Time Burden (Hours)	5,900,000	0	5,900,000
Annual IC Cost Burden (Dollars)	30,800,000	0	30,800,000

Documents for IC

Title	Document	Date Uploaded

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