Confidentiality of Substance Use Disorder Patient Records

ICR 202211-0945-002

OMB: 0945-0010

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0945-0010 can be found here:

2024-02-16 - New collection (Request for a new OMB Control Number)

Forms and Documents

Document Name	Status
12_2_2022_Part_2_ICR_Supporting_Statement.docx Supporting Statement A	2022-12-02

IC Document Collections

IC ID	Document Title	Status
256946	Reports to the Secretary	New
256945	Right to Request Restrictions	New
256944	Accounting of Disclosures of Part 2 Records	New
256942	Right to Discuss Patient Notice	New
256941	Less than 500 Affected Individuals (investigating and documenting breach) -- affecting	New
256940	Less than 500 Affected Individuals (investigating and documenting breach) -- affecting 10-499	New
256923	500 or More Affected Individuals (investigating and documenting breach)	New
256921	Notice to Secretary (notice for breaches affecting fewer than 500 individuals)	New
256920	Notice to Secretary (notice for breaches affecting 500 or more individuals)	New
256919	Media Notice - Breach	New
256918	Individual Notice-Substitute Notice (individuals' voluntary burden to call toll-free number for information)	New
256917	Individual Notice-Substitute Notice (staffing toll-free number)	New
256916	Individual Breach Notice-Substitute Notice (posting or publishing)	New
256915	Individual Breach Notice-Written and E-mail Notice (processing and sending)	New
256914	Individual Breach Notice-Written and E-mail Notice (preparing and documenting)	New
256913	Individual Breach Notice-Written and E-mail Notice (drafting)	New
256890	Disclosures for Audit & Evaluation - Paper	New
256889	Disclosures for Audit & Evaluation - Electronic	New
256888	Disclosures for Research - Paper	New
256887	Disclosures for Research - Electronic	New
256886	Documenting Emergency Treatment Disclosures	New
256885	PDMP Reporting	New
256884	Obtaining Consent for TPO	New
256883	Patient Notice - Providing to Patient	New
256881	Breach Notification - Training	New
256880	Training Program Development	New
256879	Notice to Accompany Disclosure - Updating	New
256878	Updating Consent Form	New
256877	Obtaining Consent - Training	New
256862	Requests for Restrictions - Training	New
256861	Accounting of Disclosures - Training	New
256860	Patient Notice - Updating	New
256859	Patient Notice and Right to Discuss - Training	New
256858	Complaint Procedures & Nonretaliation- Training	New

ICR Details