CONFIDENTIALITY FO ALCOHOL AND DRUG ABUSE PATIENT RECORDS NPRM

ICR 198705-0930-001

OMB: 0930-0099

Federal Form Document

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Name
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ICR Details
0930-0099 198705-0930-001
Historical Active 198308-0930-005
HHS/SAMHSA
CONFIDENTIALITY FO ALCOHOL AND DRUG ABUSE PATIENT RECORDS NPRM
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/20/1987
Retrieve Notice of Action (NOA) 05/04/1987
  Inventory as of this Action Requested Previously Approved
04/30/1989 04/30/1989
1 0 0
1 0 0
0 0 0

STATUTES REQUIRE FEDERALLY CONDUCTED, REGULATED, OR DIRECTLY OR INDIRECTLY ASSISTED ALCOHOL AND DRUG ABUSE PROGRAMS TO KEEP PATIENT RECORDS CONFIDENTIAL. INFORMATION REQUIREMENTS ARE: 1) OBTAINING WRITTEN PATIENT CONSENT, 2) DOCUMENTING "MEDICAL PERSONNEL" STATUS OF RECIPIEN OF A DISCLOSURE TO MEET A MEDICAL EMERGENCY, AND 3) NOTIFYING EACH PATIENT OF FEDERAL REQUIREMENTS.

None
None


No

1
IC Title Form No. Form Name
CONFIDENTIALITY FO ALCOHOL AND DRUG ABUSE PATIENT RECORDS NPRM

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1 0 0 1 0 0
Annual Time Burden (Hours) 1 0 0 1 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/04/1987


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