Information Collection

Licensure Forms For The Clinical Laboratory Improvement Act

IC 112979 under ICR 198204-0938-013 · OMB 0938-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0151 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	LICENSURE FORMS FOR THE CLINICAL LABORATORY IMPROVEMENT ACT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA 200	No	No
Form	201	No	No
Form	202	No	No
Form	203	No	No
Form	206	No	No
Form	209	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,359	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,359	6,359
Annual IC Time Burden (Hours)	1,851	1,851
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.