OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

IHS- 917, Request for Correction/Amendment of Protected Health Information

IC 191427 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- 917, Request for Correction/Amendment of Protected Health Information IHS 917
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction IHS- 917 Request for Correction/Amendment of Protected Health Information IHS-917_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

54 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 54 0 0 0 0 54
Annual IC Time Burden (Hours) 9 0 0 0 0 9
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.