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Federal forms, ICRs, and supporting documents

Information Collection Request

Confidentiality of Alcohol and Drug Abuse Patient Records - 42 CFR Part 2

ICR 200405-0930-002 · OMB 0930-0092 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
7502 Confidentiality of Alcohol and Drug Abuse Patient Records - 42 CFR Part 2 Migrated
ICR Details
0930-0092 200405-0930-002
Historical Active 200106-0930-001
HHS/SAMHSA
Confidentiality of Alcohol and Drug Abuse Patient Records - 42 CFR Part 2
Extension without change of a currently approved collection   No
Regular
Approved with change 08/02/2004
Retrieve Notice of Action (NOA) 05/17/2004
Approved consistent with SAMHSA memo submitted to OMB 08/02/04.
  Inventory as of this Action Requested Previously Approved
08/31/2007 08/31/2007 08/31/2004
1,760,526 0 1,485,000
353,349 0 259,876
87,000 0 73,000
Statutes require Federally conducted, regulated, or directly or indirectly assisted alcohol and drug abuse programs to keep patient records confidential. Information requirements are (1) written disclosure to patients, and (2) documenting "medical personnel" status of recipients of a disclosure to meet a medical emergency.
None
None
No
1
IC Title Form No. Form Name
Confidentiality of Alcohol and Drug Abuse Patient Records - 42 CFR Part 2
  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 1,760,526 1,485,000 0 0 275,526 0
Annual Time Burden (Hours) 353,349 259,876 0 0 93,473 0
Annual Cost Burden (Dollars) 87,000 73,000 0 0 14,000 0
No
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.
05/17/2004