OMB control number
Complaint Forms for Discrimination; Health Information Privacy Complaints
OMB 0990-0269 · HHS/HHSDM.
OMB 0990-0269
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 0990-0269_Attachment%20A[1].pdf | Supplementary Document |
 0990-0269_Supporting Statement 20083112.docx | Supporting Statement A |
 Health Information Privacy Complaint Form |
Other-form |
| Complaint Forms for Discrimination; Health Information Privacy Complaints |
Other-forms |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201209-0990-003 | Extension without change of a currently approved collection | 2012-09-28 | Approved with change | |
| 200907-0990-003 | Extension without change of a currently approved collection | 2009-07-31 | Approved without change | |
| 200803-0990-003 | No material or nonsubstantive change to a currently approved collection | 2008-03-28 | Approved without change | |
| 200604-0990-002 | Extension without change of a currently approved collection | 2006-04-13 | Approved with change | |
| 200303-0990-001 | New collection (Request for a new OMB Control Number) | 2003-03-07 | Approved without change |