HIPAA Covered Entity and Business Associate Pre-Audit Survey

ICR 201511-0945-001

OMB: 0945-0007

Federal Form Document

Forms and Documents
Document
Name
Status
Justification for No Material/Nonsubstantive Change
2015-11-25
Supporting Statement B
2014-05-16
Supporting Statement A
2015-03-13
ICR Details
0945-0007 201511-0945-001
Historical Active 201405-0945-002
HHS/OCR
HIPAA Covered Entity and Business Associate Pre-Audit Survey
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/02/2015
Retrieve Notice of Action (NOA) 11/27/2015
  Inventory as of this Action Requested Previously Approved
03/31/2018 03/31/2018 03/31/2018
700 0 700
350 0 350
0 0 0

The respondent will provide basic descriptive information about their organization. They will provide information including, but not limited to a verification of being a covered entity, the type of health care organization, the number of patients, members or transactions, their use of technology, their total revenue per fiscal year and other questions to assist OCR in determining if they are eligible candidates for HIPAA compliance audits.

PL: Pub.L. 42 - 179 13411 Name of Law: The Health Information Technology for Economic and Clinical Health Act
  
None

Not associated with rulemaking

  79 FR 10158 02/24/2014
79 FR 26963 05/12/2014
No

2
IC Title Form No. Form Name
Questionnaire - Covered Entity Administrator or Privacy Officer(s)
Questionnaire - Business Associate Administrator

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 700 700 0 0 0 0
Annual Time Burden (Hours) 350 350 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$85,000
No
No
No
No
No
Uncollected
Sherette Funn-Coleman

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/27/2015


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