Approved for use
through 9/93 under the following conditions: 1) HCFA adopts the
revised HCFA-114 and 116, glossary, and cover letter included in
this package; 2) HCFA adopts the sampling frame agreed upon with
OMB that would apply to currently regulated labs, waived labs, and
all other labs subject to CLIA. This sampling approach determines
which labs solely will receive the HCFA-114 and 116 materials with
these standard forms; 3) HCFA completes the addendu providing
baseline data for the evaluation of CLIA and a cover letter
explaining the need for the addendum no later than 8/7/92; and 4)
no later than 9/92, HCFA submits for OMB review a plan and
instrument for collecting data from laboratories that may have
closed due to the regulatory costs of CLIA. This approval applies
to the HCFA 114 and 116 and the agreed upon addendum. Due to the
likely substantial impact of CLIA on laboratory operations and
costs, HHS has developed the addendum to collect baseli information
regarding current operations that will assist in the measurement of
such impacts.
Inventory as of this Action
Requested
Previously Approved
09/30/1993
09/30/1993
04/30/1994
320,000
0
320,000
826,667
0
826,667
0
0
0
THESE FORMS MUST BE COMPLETED ENTITIES
PERFORMING LABORATORY TESTING ON HUMAN SPECIMENS FOR HEALTH
PURPOSES. THE INFORMATION ON THESE FORMS INITIATES THE
CERTIFICATION PROCESS.
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.