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Individual Notice-Substitute Notice (individuals' voluntary burden to call toll-free number for information)
Confidentiality of Substance Use Disorder Patient Records
OMB: 0945-0010
IC ID: 256918
OMB.report
HHS/OCR
OMB 0945-0010
ICR 202211-0945-002
IC 256918
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0010 can be found here:
2024-02-16 - New collection (Request for a new OMB Control Number)
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Individual Notice-Substitute Notice (individuals' voluntary burden to call toll-free number for information)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 2.16
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,265
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
2,265
2,265
0
0
0
0
Annual IC Time Burden (Hours)
283
283
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.