LICENSURE FORMS FOR THE CLINICAL LABORATORY IMPROVEMENT ACT

ICR 198502-0938-004

OMB: 0938-0151

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0151 198502-0938-004
Historical Active 198404-0938-002
HHS/CMS
LICENSURE FORMS FOR THE CLINICAL LABORATORY IMPROVEMENT ACT
Extension without change of a currently approved collection   No
Regular
Approved without change 03/12/1985
Retrieve Notice of Action (NOA) 02/14/1985
  Inventory as of this Action Requested Previously Approved
03/31/1988 03/31/1988 02/28/1985
6,359 0 6,359
1,851 0 1,851
0 0 0

CLINICAL LABORATORIES SOLICITING OR ACCEPTING SPECIMANS IN INTERSTATE COMMERCE ARE REQUIRED BY CLIA OF 1967 TO HOLD A VALID LICENSE OR LETTE OF EXEMPTION FROM LICENSURE ISSUED BY THE SECRETARY OF HHS. THESE FORMS HCFA-200-203, 206-209 ARE MECHANISMS USED TO MEET THESE REQUIRE MENTS.

None
None


No

1
IC Title Form No. Form Name
LICENSURE FORMS FOR THE CLINICAL LABORATORY IMPROVEMENT ACT HCFA 200, 201, 202, 203, 206, 209

  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 6,359 6,359 0 0 0 0
Annual Time Burden (Hours) 1,851 1,851 0 0 0 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.
02/14/1985


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