Information Collection

Covered Entity Privacy and Security Officers

IC 207132 under ICR 202405-0945-001 · OMB 0945-0005.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.