Information Collection

CLIA Budget Workload Reports and Supporting Regulations Contained in 42 CFR 493.1-.2001

IC 8199 under ICR 199805-0938-004 · OMB 0938-0599.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0599 can be found here:

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Information Collection (IC) Details

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IC Title:	CLIA Budget Workload Reports and Supporting Regulations Contained in 42 CFR 493.1-.2001	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-102				No	No
Form	HCFA-105				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	331	119	212
Annual IC Time Burden (Hours)	4,500	1,850	2,650
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.