Information Collection

Information Collection Requirements Referenced in HIPAA for the Individual Market, Supporting Regulations 45 CFR 148, and Forms/Instructions (CMS-R-205)

IC 43665 under ICR 200908-0938-001 · OMB 0938-0703.

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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 Forms/Instructions (CMS-R-205)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 148.120 45 CFR 148.122 45 CFR 145.124 45 CFR 148.126 45 CFR 148.128

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,042	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,979,801	-7,700	2,987,501
Annual IC Time Burden (Hours)	856,384	-11,763	868,147
Annual IC Cost Burden (Dollars)	0	0	0

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