HIPAA Administrative Simplification Non-Privacy Enforcement

HIPAA Administrative Simplification Non-Privacy Enforcement

OMB: 0938-0948

IC ID: 8801

Information Collection (IC) Details

View Information Collection (IC)

HIPAA Administrative Simplification Non-Privacy Enforcement
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10148 CMS-10148 - HIPAA Non-Privacy Complaint Form CMS-10148.HIPAA Non-Privacy Paper Complaint Form-11-29-06.doc Yes No Fillable Printable
Instruction CMS-10148.HIPAA Non-Provacy Complaint Information-11-29-06.DOC Yes No Fillable Printable

Health Health Care Services

 

167 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   90 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 167 0 -333 0 0 500
Annual IC Time Burden (Hours) 167 0 -333 0 0 500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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