CLIA Budget/Expenditure Report, CLIA Planned Workload Report

ICR 199702-0938-010

OMB: 0938-0599

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0599 199702-0938-010
Historical Active 199504-0938-004
HHS/CMS
CLIA Budget/Expenditure Report, CLIA Planned Workload Report
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 02/28/1997
Retrieve Notice of Action (NOA) 02/28/1997
  Inventory as of this Action Requested Previously Approved
07/31/1998 07/31/1998 07/31/1998
212 0 1
2,650 0 2,650
0 0 0

Information collected will be used by HCFA in determining the amount of Federal reimbursement for compliance surveys. Use of the information includes program evaluation, audit, budget formulation, and budget approval.

None
None


No

1
IC Title Form No. Form Name
CLIA Budget/Expenditure Report, CLIA Planned Workload Report HCFA-102, HCFA-105

  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 212 1 0 211 0 0
Annual Time Burden (Hours) 2,650 2,650 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.
02/28/1997


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