Information Collection Request

Health Breach Notification Rule

ICR 202403-3084-001 · OMB 3084-0150 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Not Applicable Notice of Breach of Health Information Form and Instruction Modified Available
Form Not Applicable Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services) Form and Instruction Modified Repair queued
Form Not Applicable Notice of Breach of Health Information Form and Instruction Modified Available
Form Not Applicable Notice for Health Applications (Non-Labor Costs for Breaches that include Forensic Services) Form and Instruction Modified Repair queued
Form Not Applicable Notice of Breach of Health Information Form and Instruction Modified Available
Form Not Applicable Major Breaches Form and Instruction Modified Repair queued
Form Not Applicable Notice of Breach of Health Information Form and Instruction Modified Available
Form Not Applicable Single-person Breaches Form and Instruction Modified Repair queued
HBNR_2024_Supporting Statement_Final .pdf Supporting Statement A Uploaded 2024-05-22 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
260390 Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services) Form and Instruction ModifiedNotice of Breach of Health Information
260390 Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services) Form and Instruction Modified
260389 Notice for Health Applications (Non-Labor Costs for Breaches that include Forensic Services) Form and Instruction ModifiedNotice of Breach of Health Information
260389 Notice for Health Applications (Non-Labor Costs for Breaches that include Forensic Services) Form and Instruction Modified
235941 Major Breaches Form and Instruction ModifiedNotice of Breach of Health Information
235941 Major Breaches Form and Instruction Modified
188848 Single-person Breaches Form and Instruction ModifiedNotice of Breach of Health Information
188848 Single-person Breaches Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2027 36 Months From Approved 07/31/2025
2,583 0 2,501
16,954 0 4,654
92,016,002 0 31,632





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Major Breaches Not Applicable
Notice for Health Applications (Non-Labor Costs for Breaches that include Forensic Services) Not Applicable
Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services) Not Applicable
Single-person Breaches Not Applicable

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,583 2,501 0 82 0 0
Annual Time Burden (Hours) 16,954 4,654 0 12,300 0 0
Annual Cost Burden (Dollars) 92,016,002 31,632 0 91,984,370 0 0


Reginfo record details
  No