LABORATORY PERSONNEL QUALIFICATION APPRAISAL

ICR 198910-0938-003

OMB: 0938-0049

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
112652 Migrated
ICR Details
0938-0049 198910-0938-003
Historical Active 198808-0938-009
HHS/CMS
LABORATORY PERSONNEL QUALIFICATION APPRAISAL
Extension without change of a currently approved collection   No
Regular
Approved without change 01/05/1990
Retrieve Notice of Action (NOA) 10/10/1989
  Inventory as of this Action Requested Previously Approved
01/31/1991 01/31/1991 11/30/1989
3,000 0 3,000
1,000 0 1,000
0 0 0

THIS FORM MUST BE COMPLETED BY PERSONNEL EMPLOYED BY INDEPENDENT LABORATORIES CERTIFIED BY MEDICARE. IT IS SUBMITTED TO THE STATE SURVEY AGENCY WHICH VERIFIE THAT THE LABORATORY'S PERSONNEL MEET REGULATORY STANDARDS FOR EDUCATIO TRAINING AND TESTING.

None
None


No

1
IC Title Form No. Form Name
LABORATORY PERSONNEL QUALIFICATION APPRAISAL HCFA-3083

  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) 1,000 1,000 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.
10/10/1989


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