Confidentiality of Substance Use Disorder Patient Records

ICR 202401-0945-001

OMB: 0945-0010

Federal Form Document

Forms and Documents

Document Name	Status
Part_2_ICR_Supporting_Statement 2_7_2024.docx Supporting Statement A	2024-02-07

IC Document Collections

IC ID	Document Title	Status
264408	Programs Receiving a Complaint	New
264402	Attach consent form with each disclosure (paper records)	New
264401	Attach consent form with each disclosure (electronic records)	New
256946	Reports to the Secretary	Modified
256945	Right to Request Restrictions	Modified
256944	Accounting of Disclosures of Part 2 Records	Unchanged
256942	Right to Discuss Patient Notice	Unchanged
256941	Less than 500 Affected Individuals (investigating and documenting breach) -- affecting	Unchanged
256940	Less than 500 Affected Individuals (investigating and documenting breach) -- affecting 10-499	Unchanged
256923	500 or More Affected Individuals (investigating and documenting breach)	Modified
256921	Notice to Secretary (notice for breaches affecting fewer than 500 individuals)	Unchanged
256920	Notice to Secretary (notice for breaches affecting 500 or more individuals)	Unchanged
256919	Media Notice - Breach	Modified
256918	Individual Notice-Substitute Notice (individuals' voluntary burden to call toll-free number for information)	Unchanged
256917	Individual Notice-Substitute Notice (staffing toll-free number)	Unchanged
256916	Individual Breach Notice-Substitute Notice (posting or publishing)	Unchanged
256915	Individual Breach Notice-Written and E-mail Notice (processing and sending)	Modified
256914	Individual Breach Notice-Written and E-mail Notice (preparing and documenting)	Unchanged
256913	Individual Breach Notice-Written and E-mail Notice (drafting)	Unchanged
256890	Disclosures for Audit & Evaluation - Paper	Unchanged
256889	Disclosures for Audit & Evaluation - Electronic	Unchanged
256888	Disclosures for Research - Paper	Unchanged
256887	Disclosures for Research - Electronic	Unchanged
256886	Documenting Emergency Treatment Disclosures	Unchanged
256885	PDMP Reporting	Unchanged
256884	Obtaining Consent for TPO	Unchanged
256883	Patient Notice - Providing to Patient	Modified
256881	Breach Notification - Training	Unchanged
256880	Training Program Development	Unchanged
256879	Notice to Accompany Disclosure - Updating	Unchanged
256878	Updating Consent Form	Unchanged
256877	Obtaining Consent - Training	Unchanged
256862	Requests for Restrictions - Training	Unchanged
256861	Accounting of Disclosures - Training	Unchanged
256860	Patient Notice - Updating	Unchanged
256859	Patient Notice and Right to Discuss - Training	Modified
256858	Complaint Procedures & Nonretaliation- Training	Unchanged