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Federal forms, ICRs, and supporting documents

Information Collection

IHS-912-2, Request for Revocation of Restriction(s)

IC 191425 under ICR 202309-0917-001 · OMB 0917-0030.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

IHS-912-2, Request for Revocation of Restriction(s)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction IHS 912-2 Request for Revocation of Restriction(s IHS-912-2_508 - 2023.docx Yes No Fillable Fileable

Health Health Care Services

IHS Privacy Act system notice 09 17 0001, IHS Medical, Health and Billing Records  75 FR 1625

3 0
   
Individuals or Households
 
   0 %

  Approved 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 3 0 0 0 0 3
Annual IC Time Burden (Hours) 1 0 0 0 0 1
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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