Information Collection Request

Health Breach Notification Rule

ICR 201208-3084-004 · OMB 3084-0150 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Health Breach Notif. Rule '12 SS fin_mtd.pdf Supporting Statement A Uploaded 2012-08-23 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
188849 Creating a toll-free line & related non-labor costs Removed
188848 Identifying breach, affected customers, notifying customers, etc. Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2015 36 Months From Approved 09/30/2012
2 0 22
200 0 34,837
7,918 0 260,657





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Identifying breach, affected customers, notifying customers, etc.
Creating a toll-free line & related non-labor costs

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2 22 0 0 -20 0
Annual Time Burden (Hours) 200 34,837 0 0 -34,637 0
Annual Cost Burden (Dollars) 7,918 260,657 0 0 -252,739 0


Reginfo record details
  No