Information Collection

IHS-982, Acknowledgement of Receipt of the Notice of Privacy Practices Protected Health Information

IC 262274 under ICR 202309-0917-001 · OMB 0917-0030.

Documents and Forms

Document Name Document Type
Form IHS-982 IHS-982, Acknowledgement of Receipt of the Notice of Privacy Practices Protected Health Information Form and Instruction
IHS-982 Acknowledgement of receipt of the Notice of Privacy Prac IHS-982 - 2023.docx Form and Instruction
IHS-982 Acknowledgement of receipt of the Notice of Privacy Prac IHS-982 - 2023.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	IHS-982, Acknowledgement of Receipt of the Notice of Privacy Practices Protected Health Information	Agency IC Tracking Number:	IHS-982

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	IHS-982	Acknowledgement of receipt of the Notice of Privacy Practices Protected Health Information	IHS-982 - 2023.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: IHS Privacy Act system notice 09 17 0001, IHS Medical, Health and Billing Records	FR Citation: 75 FR 1625

Number of Respondents: 39	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	39	39
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	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.