Information Collection Request

Health Breach Notification Rule

ICR 202205-3084-001 · OMB 3084-0150 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Not Applicable Notice of Breach of Health Information Form and Instruction Modified Available
Form Not Applicable Major Breaches Form and Instruction Modified Repair queued
Form Not Applicable Notice of Breach of Health Information Form and Instruction Modified Available
Form Not Applicable Single-person Breaches Form and Instruction Modified Repair queued
Health Breach Notification Rule - SS-2022-FINAL.pdf Supporting Statement A Uploaded 2022-06-03 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
235941 Major Breaches Form and Instruction ModifiedNotice of Breach of Health Information
235941 Major Breaches Form and Instruction Modified
188848 Single-person Breaches Form and Instruction ModifiedNotice of Breach of Health Information
188848 Single-person Breaches Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2025 36 Months From Approved 07/31/2022
2,501 0 25,001
4,654 0 4,779
31,632 0 29,952





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Major Breaches Not Applicable
Single-person Breaches Not Applicable

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 2,501 25,001 0 0 -22,500 0
Annual Time Burden (Hours) 4,654 4,779 0 0 -125 0
Annual Cost Burden (Dollars) 31,632 29,952 0 0 1,680 0


Reginfo record details
  No