# Agency Information Collection Activities; Proposed Collection; Public Comment Request
**AGENCY:**
Office of the Secretary, HHS.
**ACTION:**
Notice.
**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, announces plans to submit an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB). The ICR is for extending the use of the approved information collection assigned OMB control number 0945-0002, which expires on 12/31/2015. Prior to submitting the ICR to OMB, OS seeks comments from the public regarding the burden estimate, below, or any other aspect of the ICR.
**DATES:**
Comments on the ICR must be received on or before December 21, 2015.
**ADDRESSES:**
Submit your comments to *[email protected]* or by calling (202) 690-6162.
**FOR FURTHER INFORMATION CONTACT:**
Information Collection Clearance staff, *[email protected]* or (202) 690-6162.
**SUPPLEMENTARY INFORMATION:**
When submitting comments or requesting information, please include the document identifier HHS-OS-0945-0002-60D for reference.
*Proposed Project:* Complaint Forms for Discrimination; Health Information Privacy Complaints.
OMB No. 0945-0002—Extension—Office of Civil Rights.
*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.
| Forms | Type of respondent | Number of | Number of | Average | Total burden hours |
| --- | --- | --- | --- | --- | --- |
| Civil Rights Complaint Form | Individuals or households, Not-for-profit institutions | 3493 | 1 | 45/60 | 2620 |
| Health Information Privacy Complaint Form | Individuals or households, Not-for-profit institutions | 10,286 | 1 | 45/60 | 7715 |
| Total | | | | | 10,335 |
OS specifically requests comments on (1) the necessity and utility of the proposed information collection for the proper performance of the agency's functions, (2) the accuracy of the estimated burden, (3) ways to enhance the quality, utility, and clarity of the information to be collected, and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
Darius Taylor,
Information Collection Clearance Officer.