DEPARTMENTAL CLINICAL LABORATORY SURVEY REPORT

ICR 198203-0938-010

OMB: 0938-0032

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
166066 Migrated
ICR Details
0938-0032 198203-0938-010
Historical Active 197712-0938-004
HHS/CMS
DEPARTMENTAL CLINICAL LABORATORY SURVEY REPORT
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/30/1982
Approved with change 03/30/1982
Retrieve Notice of Action (NOA) 03/30/1982
  Inventory as of this Action Requested Previously Approved
11/30/1982 11/30/1982 11/30/1982
3,000 0 3,000
35,000 0 18,000
0 0 0

SECTION 1861(S)(3) OF THE SOCIAL SECURITY ACT AUTHORIZES MEDICARE REIMBURSEMENT OF DIAGNOSTIC LABORATORY TESTS IF THE PERFORMANCE OF SUCH TESTS MEETS THE CONDITIONS RELATING TO HEALTH AND SAFETY. THE INFORMATION ON THIS FORM IS COLLECTED AND EVALUATED BY THE STATE AGENCY TO DETERMINE COMPLIANCE WITH THIS REQUIREMENT.

None
None


No

1
IC Title Form No. Form Name
DEPARTMENTAL CLINICAL LABORATORY SURVEY REPORT HCFA-1557

  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 3,000 3,000 0 0 0 0
Annual Time Burden (Hours) 35,000 18,000 0 0 17,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 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.
03/30/1982


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