Information Collection

Clinical Laboratory Improvement Amendments Of 1988, Fee Collection -- 42 Cfr Sections 493.614, 493.633, And 493.634

IC 114063 under ICR 199203-0938-003 · OMB 0938-0607.

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IC Title:

CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988, FEE COLLECTION -- 42 CFR SECTIONS 493.614, 493.633, AND 493.634

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-14				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
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.