[Federal Register Volume 77, Number 188 (Thursday, September 27, 2012)]
[Notices]
[Pages 59401-59402]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-23776]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

[Document Identifier: HHS-OS-17264-30D]


Agency Information Collection Activities; Submission to OMB for 
Review and Approval; Public Comment Request

ACTION: 30-day Notice.

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SUMMARY: In compliance with section 3506(c)(2)(A) of the Paperwork 
Reduction Act of 1995, the Office of the Secretary (OS), Department of 
Health and Human Services, will submit an Information Collection 
Request (ICR), described below, to the Office of Management and Budget 
(OMB) for review and approval. The ICR is for renewal of the approved 
information collection assigned OMB control number 0990-0269, scheduled 
to expire on September 30, 2012. Comments submitted during the first 
public review of this ICR will be provided to OMB. OMB will accept 
further comments from the public on this ICR during the review and 
approval period.
    Deadline: Comments on the ICR must be received within 30 days of 
the issuance of this notice.

ADDRESSES: Submit your comments, including the OMB control number  
and document identifier HHS-OS-17264-30D, to [email protected] or via facsimile to (202) 395-5806. Copies of 
the supporting statement and any related forms may be requested via 
email to [email protected] or by calling (202) 
690-6162.
    Information Collection Request Title: Complaint Forms for 
Discrimination; Health Information Privacy Complaints.
    Abstract: The Office for Civil Rights is seeking an extension on an 
approval for a 3-year clearance on a previous collection. Individuals 
may file written complaints with the Office for Civil Rights when they 
believe they have been discriminated against by programs or entities 
that receive Federal financial assistance from the Health and Human 
Service or if they believe that their right to the privacy of protected 
health information has been violated. Annual Number of Respondents 
frequency of submission is record keeping and reporting on occasion.
    Burden Statement: Burden in this context means the time expended by 
persons to generate, maintain, retain, disclose or provide the 
information requested. This includes the time needed to review 
instructions, to develop, acquire, install and utilize technology and 
systems for the purpose of collecting, validating and verifying 
information, processing and maintaining information, and disclosing and 
providing information, to train personnel and to be able to respond to 
a collection of information, to search data sources, to complete and 
review the collection of information, and to transmit or otherwise 
disclose the information. The total annual burden hours estimated for 
this ICR are summarized in the table below.

[[Page 59402]]



                                    Total Estimated Annualized Burden--Hours
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                                                                     Number of        Average
             Forms                   Type of         Number of     responses per   burden hours    Total burden
                                   respondent       respondents     respondent     per response        hours
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Civil Rights Complaint Form...  Individuals or             3,493               1           45/60           2,620
                                 households, Not-
                                 for-profit
                                 institutions.
Health Information Privacy      Individuals or            10,286               1           45/60           7,715
 Complaint Form.                 households, Not-
                                 for-profit
                                 institutions.
                                                 ---------------------------------------------------------------
    Total.....................  ................  ..............  ..............  ..............          10,335
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Keith A. Tucker,
Information Collection Clearance Officer, Department of Health and 
Human Services.
[FR Doc. 2012-23776 Filed 9-26-12; 8:45 am]
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