Information Collection

Less than 500 Affected Individuals (investigating and documenting breach)affecting

IC 205902 under ICR 201302-0945-002 · OMB 0945-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Less than 500 Affected Individuals (investigating and documenting breach)affecting <10 individuals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 160

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

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,810

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,810	17,810
Annual IC Time Burden (Hours)	71,240	71,240
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.