Information Collection Request

Health Breach Notification Rule

ICR 202305-3084-001 · OMB 3084-0150 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Not Applicable Notice of Breach of Health Information Form and Instruction Unchanged Available
Form Not Applicable Major Breaches Form and Instruction Unchanged Available
Form Not Applicable Notice of Breach of Health Information Form and Instruction Unchanged Available
Form Not Applicable Single-person Breaches Form and Instruction Unchanged Repair queued
Health Breach Notification Rule - 2023 Supporting Statement - Final.pdf Supporting Statement A Uploaded 2023-06-07 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
260390 Notice to Consumers (Non-Labor Costs for Breaches without Forensic Services) New
260389 Notice to Consumers (Non-Labor Costs for Breaches that include Forensic Services) New
235941 Major Breaches Form and Instruction UnchangedNotice of Breach of Health Information
235941 Major Breaches Form and Instruction Unchanged
188848 Single-person Breaches Form and Instruction UnchangedNotice of Breach of Health Information
188848 Single-person Breaches Form and Instruction Unchanged

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 07/31/2025
2,501 0 2,501
4,654 0 4,654
31,632 0 31,632





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Major Breaches Not Applicable
Notice to Consumers (Non-Labor Costs for Breaches that include Forensic Services)
Notice to Consumers (Non-Labor Costs for Breaches without Forensic Services)
Single-person Breaches Not Applicable



Reginfo record details
  No