Information Collection

42 Cfr 2.51

IC 181480 under ICR 201008-0930-005 · OMB 0930-0092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0092 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SAMHSAHIPAAComparisonClearedPDFVersion.pdf	Other-Regulation and HIPAA Rule

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Regulation and HIPAA Rule			SAMHSAHIPAAComparisonClearedPDFVersion.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,064

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,128	-1,130	21,258
Annual IC Time Burden (Hours)	3,361	-189	3,550
Annual IC Cost Burden (Dollars)	0	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.