Information Collection

ICRs Contained in 45 CFR Part 162; HIPAA Standards for Electronic Transactions

IC 8683 under ICR 200802-0938-005 · OMB 0938-0866.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0866 can be found here:

Documents and Forms

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR Part 162 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	X061A1.pdf	Yes	No	Fillable Printable
Instruction	X091A1.pdf	Yes	No	Fillable Fileable
Instruction	X092A1.pdf	Yes	No	Fillable Printable
Instruction	X093A1.pdf	Yes	No	Fillable Fileable
Instruction	X094A1.pdf	Yes	No	Fillable Fileable
Instruction	X095A1.pdf	Yes	No	Fillable Fileable
Instruction	X098A1.pdf	Yes	No	Fillable Fileable
Instruction	X096A1.pdf	Yes	No	Fillable Fileable
Instruction	X097A1.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,400,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,400,000	3,400,000
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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