Information Collection Request

Health Breach Notification Rule

ICR 201601-3084-001 · OMB 3084-0150 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Not Applicable Identifying breach, affected customers, notifying customers, etc. Form and Instruction Modified Repair queued
Health Breach Notif. Rule - SS - 2016 - FINAL .pdf Supporting Statement A Uploaded 2016-01-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
188848 Identifying breach, affected customers, notifying customers, etc. Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2019 36 Months From Approved 03/31/2016
2 0 2
3,267 0 200
49,960 0 7,918





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Identifying breach, affected customers, notifying customers, etc. Not Applicable Notice of Breach of Health Information

table that charts list of burden
  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 2 2 0 0 0 0
Annual Time Burden (Hours) 3,267 200 0 0 3,067 0
Annual Cost Burden (Dollars) 49,960 7,918 0 0 42,042 0


Reginfo record details
  No