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0990-0269_Attachment%20A[1]
0990-0269_Attachment%20A[1].pdf
Complaint Forms for Discrimination; Health Information Privacy Complaints
0990-0269_Attachment%20A[1]
OMB: 0945-0002
OMB.report
HHS/OCR
OMB 0945-0002
ICR 201906-0945-004
0990-0269_Attachment%20A[1]
( Supplementary Document )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0945-0002 can be found here:
2022-10-31 - Extension without change of a currently approved collection
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