OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

HITECH Act Breach Notification

OMB 0945-0001 · HHS/OCR.

OMB 0945-0001

Latest Forms, Documents, and Supporting Material

Document Name
0990-BreachPRA Supplementary Statement.doc Supplementary Document
0990-BreachPRA Supplementary Statement.doc Supplementary Document
0990-BreachPRA Supplementary Statement.doc Supplementary Document
18737 ID_0945-0001_HITECH_Omnibus_Breach_020120131.doc Supporting Statement A
Individual Notice--Substitute Notice (setting up and staffing toll-free number)
Less than 500 Affected Individuals (investigating and documenting breach)affecting
Individual Notice--Written and E-mail Notice (processing and sending)
Individual Notice--Written and E-mail Notice (preparing and documenting notification)
Individual Notice--Substitute Notice (posting or publishing)
Notice to Secretary(notice for breaches affecting fewer than 500 individuals)
Media Notice
Individual Notice substitute Notice
Less than 500 affected individuals
500 or more affected Individuals
Individual Notice Written and E-mail Notice

All Historical Document Collections

201302-0945-002 Approved with change	Revision of a currently approved collection	2013-02-22
201211-0945-001 Approved without change	Extension without change of a currently approved collection	2012-11-09