[Federal Register Volume 77, Number 191 (Tuesday, October 2, 2012)]
[Notices]
[Pages 60129-60130]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-24119]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


60-Day Proposed Information Collection: Indian Health Service 
Forms To Implement the Privacy Rule; Request for Public Comment

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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SUMMARY: In compliance with Section 3506(c)(2)(A) of the Paperwork 
Reduction Act of 1995, which requires 60 days for public comment on 
proposed information collection projects, the Indian Health Service 
(IHS) is publishing for comment a summary of a proposed information 
collection to be submitted to the Office of Management and Budget (OMB) 
for review.
    Proposed Collection: Title: 0917-0030, ``IHS Forms to Implement the 
Privacy Rule (45 CFR Parts 160 & 164)''. Type of Information Collection 
Request: Extension, without revisions, of currently approved 
information collection, 0917-0030, ``IHS Forms to Implement the Privacy 
Rule (45 CFR Parts 160 & 164)''. Form Number(s): IHS-810, IHS-912-1, 
IHS-912-2, IHS-913 and IHS-917. Need and Use of Information Collection: 
This collection of information is made necessary by the Department of 
Health and Human Services Rule entitled ``Standards for Privacy of 
Individually Identifiable Health Information'' (Privacy Rule) (45 CFR 
parts 160 and 164). The Privacy Rule implements the privacy 
requirements of the Administrative Simplification subtitle of the 
Health Insurance Portability and Accountability Act of 1996, creates 
national standards to protect individual's personal health information, 
and gives patients increased access to their medical records. 45 CFR 
164.508, 164.522, 164.526 and 164.528 of the Rule require the 
collection of information to implement these protection standards and 
access requirements. The IHS will continue to use the following data 
collection instruments to meet the information collection requirements 
contained in the Rule.
    45 CFR 164.508: This provision requires covered entities to obtain 
or receive a valid authorization for its use or disclosure of protected 
health information for other than for treatment, payment and healthcare 
operations. Under the provision individuals may initiate a written 
authorization permitting covered entities to release their protected 
health information to entities of their choosing. The form IHS-810 
``Authorization for Use or Disclosure of Protected Health Information'' 
is used to document an individual's authorization to use or disclose 
their protected health information.
    45 CFR 164.522: Section 164.522(a)(1) requires a covered entity to 
permit individuals to request that the covered entity restrict the use 
and disclosure of their protected health information. The covered 
entity may or may not agree to the restriction. The form IHS-912-1 
``Request for Restrictions(s)'' is used to document an individual's 
request for restriction of their protected health information, and 
whether IHS agreed or disagreed with the restriction. Section 
164.522(a)(2) permits a covered entity to terminate its agreement to a 
restriction if the individual agrees to or requests the termination in 
writing. The form IHS-912-2 ``Request for Revocation of 
Restriction(s)'' is used to document the agency or individual request 
to terminate a formerly agreed to restriction regarding the use and 
disclosure of protected health information.
    45 CFR 164.528 and 45 CFR 5b.9(c): This provision requires covered 
entities to permit individuals to request that the covered entity 
provide an accounting of disclosures of protected health information 
made by the covered entity. The form IHS-913 ``Request for an 
Accounting of Disclosures'' is used to document an individual's request 
for an accounting of disclosures of their protected health information 
and the agency's handling of the request.
    45 CFR 164.526: This provision requires covered entities to permit 
an individual to request that the covered entity amend protected health 
information. If the covered entity accepts the requested amendment, in 
whole or in part, the covered entity must inform the individual that 
the amendment is accepted. If the covered entity denies the requested 
amendment, in whole or in part, the covered entity must provide the 
individual with a written denial. The form IHS-917 ``Request for 
Correction/Amendment of Protected Health Information'' will be used to 
document an individual's request to amend their protected health 
information and the agency's decision to accept or deny the request. 
Completed forms used in this collection of information are filed in the 
IHS medical, health and billing record, a Privacy Act System of Records 
Notice. Affected Public: Individuals and households. Type of 
Respondents: Individuals. Burden Hours: The table below provides the 
estimated burden hours for this information collection:

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                                                                                  Average burden
           Data collection instrument                Number of     Responses per     hour per      Total annual
                                                    respondents     respondent      response *     burden hours
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Authorization for Use or Disclosure of Protected         500,000               1           20/60         166,667
 Health Information (OMB Form No. 0917-0030, IHS-
 810)...........................................
Request for Restriction(s) (OMB Form No. 0917-            15,000               1           10/60           2,500
 0030, IHS-912-1)...............................
Request for Revocation of Restriction(s) (OMB              5,000               1           10/60             833
 Form No. 0917-0030, IHS-912-2).................
Request for Accounting of Disclosures (OMB Form           15,000               1           10/60           2,500
 No. 0917-0030, IHS-913)........................
Request for Correction/Amendment of Protected              7,500               1           15/60           1,875
 Health Information (OMB Form No. 0917-0030, IHS-
 917)...........................................
                                                 ---------------------------------------------------------------
    Total Annual Burden.........................  ..............               5  ..............         174,375
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* For ease of understanding, burden hours are provided in actual minutes.


[[Page 60130]]

    The total estimated burden for this collection of information is 
174,375 hours. There are no capital costs, operating costs and/or 
maintenance costs to respondents.
    Request for Comments: Your written comments and/or suggestions are 
invited on one or more of the following points: (a) Whether the 
information collection activity is necessary to carry out an agency 
function; (b) whether the agency processes the information collected in 
a useful and timely fashion; (c) the accuracy of public burden estimate 
(the estimated amount of time needed for individual respondents to 
provide the requested information); (d) whether the methodology and 
assumptions used to determine the estimate are logical; (e) ways to 
enhance the quality, utility, and clarity of the information being 
collected; and (f) ways to minimize the public burden through the use 
of automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology.
    Send Comments and Requests for Further Information: Send your 
written comments and requests for more information on the proposed 
collection or requests to obtain a copy of the data collection 
instrument(s) and instructions to: Tamara Clay, IHS Reports Clearance 
Officer, 801 Thompson Avenue, TMP, Suite 450, Rockville, MD 20852, call 
non-toll free (301) 443-1611, send via facsimile to (301) 443-2316, or 
send your email requests, comments, and return address to: 
[email protected].
    Comment Due Date: Your comments regarding this information 
collection are best assured of having their full effect if received 
within 60 days of the date of this publication.

    Dated: September 20, 2012.
Yvette Roubideaux,
Director, Indian Health Service.
[FR Doc. 2012-24119 Filed 10-1-12; 8:45 am]
BILLING CODE 4165-16-P