Information Collection

Dissemination of Notice of Privacy Practices for Protected Health Information(health Plans)

IC 208574 under ICR 201309-0945-001 · OMB 0945-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0003 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Dissemination of Notice of Privacy Practices for Protected Health Information(health Plans)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 160-164 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection 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: 20,000,000	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	20,000,000	20,000,000
Annual IC Time Burden (Hours)	66,667	66,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.