Information Collection Request
Complaint Forms for Civil Rights and Conscience; Health Information Privacy and Security Complaints
ICR 202209-0945-001 · OMB 0945-0002 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0945-0002 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0945-0002 Civil Rights and Conscience Complaint |
Form | Modified | Repair queued |
 10-31 updated to add annualized cost per PRA officer Final 7-7-22 Supporting document HH.docx |
Supporting Statement A | Uploaded 2022-10-31 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 236663 |  Civil Rights and Conscience Complaint |
Form | Modified | |
| 190142 | Health Information Privacy and Security Complaint |
Other-form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/OCR |
| OMB Control No | 0945-0002 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201906-0945-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |