OMB.report

Federal forms, ICRs, and supporting documents

Document

HIPAA ADMINISTRATIVE SIMPLIFICATION (NON-PRIVACY/SECURITY) COMPLAINT FORM

ICR 202606-0938-005 · OMB 0938-0948 · Object 169650401.

Document Viewer [docx]

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

Primary: docxSource: application/octet-stream
Loading document viewer…

Document Metadata

Record metadata
File Typeapplication/octet-stream
File TitleHIPAA ADMINISTRATIVE SIMPLIFICATION (NON-PRIVACY/SECURITY) COMPLAINT FORM
AuthorHHS/CMS
Last Modified ByWriter
File Modified2026-05-13
File Created2026-06-17
Conversion Statecomplete