Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services)

Health Breach Notification Rule

Documents and Forms

Document Name Document Type
Form Not Applicable Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services) Form and Instruction
Not Applicable Notice of Breach of Health Information 2024.05.22 Notice of Breach of Health Information Form Reporting Form.pdf Form and Instruction
Not Applicable Notice of Breach of Health Information 2024.05.22 Notice of Breach of Health Information Form Reporting Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Notice for Health Applications (Non-Labor Costs for Breaches without Forensic Services)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 16 CFR 318

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Not Applicable	Notice of Breach of Health Information	2024.05.22 Notice of Breach of Health Information Form Reporting Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	4,950	4,950
Annual IC Cost Burden (Dollars)	36,401,748	36,401,748

Documents for IC

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.