Information Collection

Covered Entity Privacy and Security Officers

IC 207132 under ICR 201305-0945-002 · OMB 0945-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0005 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0945-OCRrev_Task 4.4.3 OMB Justification Package 2013-05-22 Appendix D Instrument.docx	Other-survey

IC Title:

Covered Entity Privacy and Security Officers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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-survey			0945-OCRrev_Task 4.4.3 OMB Justification Package 2013-05-22 Appendix D Instrument.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 115

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	115	115
Annual IC Time Burden (Hours)	52	52
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.