Laboratory Personnel Report (CLIA)

ICR 199610-0938-007

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
7862 Migrated
ICR Details
0938-0151 199610-0938-007
Historical Active 199410-0938-016
HHS/CMS
Laboratory Personnel Report (CLIA)
Extension without change of a currently approved collection   No
Regular
Approved without change 01/06/1997
Retrieve Notice of Action (NOA) 10/29/1996
This extension of the HCFA-209 is approved for use through 1/2000 under the condition that HCFA immediately incorporates the disclosure statements into the forms/instructions as mandated by the Paperwork Reduction Act of 1995. For the public record, HCFA must submit to OMB the revised forms/instructions.
  Inventory as of this Action Requested Previously Approved
02/29/2000 02/29/2000 01/31/1997
13,125 0 26,250
6,563 0 13,125
0 0 0

This form is used by the State agency to determine a laboratory's compliance with personnel qualifications under CLIA. This information is needed for a laboratory's CLIA 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 13,125 26,250 0 -13,125 0 0
Annual Time Burden (Hours) 6,563 13,125 0 -6,562 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
10/29/1996


© 2024 OMB.report | Privacy Policy