Information Collection

Licensure Forms For The Clinical Laboratory Improvement Act

IC 112981 under ICR 198502-0938-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type

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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: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded

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