OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Appx N_ Release of Information (HIPPA) (M/FF/CW)

IC 243423 under ICR 202310-0920-010 · OMB 0920-1331.

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

View Information Collection (IC)

Appx N_ Release of Information (HIPPA) (M/FF/CW) 0920-1331
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1331 Release of Information (HIPAA Privacy Authorization Form) Appendix N Release of Information (HIPAA).docx Yes Yes Fillable Fileable

Workforce Management Worker Safety

 

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

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.