IHS- 913, Request for Accounting of Disclosures

IHS Forms To Implement The Privacy Rule (45 CFR Parts 160 and 164)

OMB: 0917-0030

IC ID: 191426

Documents and Forms
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IHS- 913, Request for Accounting of Disclosures
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 913 Request for Account of Disclosures IHS-913_508 - 2016.docx Yes No Fillable Printable

Health Health Care Services

IHS Privacy Act system notice 09 17 0001, IHS Medical, Health and Billing Records  75 FR 1625

39 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 39 0 0 -14,961 0 15,000
Annual IC Time Burden (Hours) 7 0 0 -2,493 0 2,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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