Covered Entity Privacy and Security Officers

HIPAA Audit Review Survey

Documents and Forms

Document Name Document Type
HIPAA Audit Participant Survey.pdf forms.office.com/Pages/ResponsePage.aspx?id=6t2K1VNQgEqEmbpNlEkQ3255StEpcjtIspm8c6B8agpUOVRRSzNaRU0yMUtTREVQTEtLNFlUVEcw Other-Survey
HIPAA Audit Participant Survey.pdf forms.office.com/Pages/ResponsePage.aspx?id=6t2K1VNQgEqEmbpNlEkQ3255StEpcjtIspm8c6B8agpUOVRRSzNaRU0yMUtTREVQTEtLNFlUVEcw Other-Survey

Information Collection (IC) Details

IC Title:	Covered Entity Privacy and Security Officers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Survey			HIPAA Audit Participant Survey.pdf	https://forms.office.com/Pages/ResponsePage.aspx?id=6t2K1VNQgEqEmbpNlEkQ3255StEpcjtIspm8c6B8agpUOVRRSzNaRU0yMUtTREVQTEtLNFlUVEcwMy4u	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 166	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	166	166
Annual IC Time Burden (Hours)	125	125
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.