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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
0945-OCRrev_Task 4.4.3 OMB Justification Package 2013-05-22 Appendix D Instrument.docx Other-survey

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.