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Federal forms, ICRs, and supporting documents

Information Collection

Individual Notice--Written and E-mail Notice (preparing and documenting notification)

IC 205900 under ICR 201302-0945-002 · OMB 0945-0001.

Documents and Forms
Document Name
Document Type
IC Document
Information Collection (IC) Details

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Individual Notice--Written and E-mail Notice (preparing and documenting notification)
 
No New
 
Voluntary
 
45 CFR 160

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

Health Illness Prevention

 

19,000 0
   
Individuals or Households
 
   0 %

  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 19,000 0 19,000 0 0 0
Annual IC Time Burden (Hours) 9,500 0 9,500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0990-BreachPRA Supplementary Statement 0990-BreachPRA Supplementary Statement.doc 12/23/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.