Information Collection

Information Collection Requirements Referenced in HIPAA for the Individual Market -- Supporting Regulations 45 CFR 148 and Form/Instructions

IC 8336 under ICR 199910-0938-003 · OMB 0938-0703.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0703 can be found here:

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Information Collection (IC) Details

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IC Title:	Information Collection Requirements Referenced in HIPAA for the Individual Market -- Supporting Regulations 45 CFR 148 and Form/Instructions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

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-205				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,040	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	3,230,000	230,000	3,000,000
Annual IC Time Burden (Hours)	921,000	21,000	900,000
Annual IC Cost Burden (Dollars)	0	0	0

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Title	Document	Date Uploaded

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