IHS- 917, Request for Correction/Amendment of Protected Health Information

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

OMB: 0917-0030

IC ID: 191427

Information Collection (IC) Details

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IHS- 917, Request for Correction/Amendment of Protected Health Information
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 917 Request for correction/Amendment of Protected Health Information IHS-917_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

54 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 54 0 0 0 0 54
Annual IC Time Burden (Hours) 9 0 0 0 0 9
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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