LABORATORY PERSONNEL REPORT (CLIA)

ICR 199310-0938-011

OMB: 0938-0151

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
112986 Migrated
ICR Details
0938-0151 199310-0938-011
Historical Active 199207-0938-008
HHS/CMS
LABORATORY PERSONNEL REPORT (CLIA)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 11/05/1993
Retrieve Notice of Action (NOA) 10/04/1993
Approved for use through 12/94 under the condition that no later than 94, HCFA describes to OMB its plans to amend existing CLIA regulations and surveyor guidelines to streamline burdensome, unnecessary information collection burdens imposed on clinical laboratories (e.g., through reliance on updated certifications, etc.)
  Inventory as of this Action Requested Previously Approved
01/31/1995 01/31/1995
31,200 0 0
15,600 0 0
0 0 0

THIS FORM IS USED TO DETERMINE LABORATORY COMPLIANCE WITH THE PERSONNE REQUIREMENTS UNDER CLIA. THIS INFORMATION IS NEEDED FOR LABORATORY CERTIFICATION AND RECERTIFICATION.

None
None


No

1
IC Title Form No. Form Name
LABORATORY PERSONNEL REPORT (CLIA) HCFA-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 31,200 0 0 31,200 0 0
Annual Time Burden (Hours) 15,600 0 0 15,600 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
10/04/1993


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