Information Collection

Information Collection Requirements Referenced in HIPAA, Title 1 for the Individual Market, Supporting Regulations at 45 CFR 148.120, 148.122, 148.124, 148.126, and 148.128, and Forms/....

IC 8337 under ICR 200303-0938-001 · OMB 0938-0703.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Information Collection Requirements Referenced in HIPAA, Title 1 for the Individual Market, Supporting Regulations at 45 CFR 148.120, 148.122, 148.124, 148.126, and 148.128, and Forms/....	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	CMS-R-205				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,041	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,242,500	12,500	3,230,000
Annual IC Time Burden (Hours)	914,347	-8,653	923,000
Annual IC Cost Burden (Dollars)	0	0	0

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.