Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777

ICR 200605-0938-004

OMB: 0938-0653

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0653 200605-0938-004
Historical Active 200307-0938-009
HHS/CMS
Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777
Extension without change of a currently approved collection   No
Regular
Approved with change 08/04/2006
Retrieve Notice of Action (NOA) 05/15/2006
Due to a low response rate, CMS should continue not to use information collected through this collection as an impetus for program changes without further coordination with OMB.
  Inventory as of this Action Requested Previously Approved
08/31/2009 36 Months From Approved 09/30/2006
10,500 0 11,250
2,625 0 2,813
0 0 0

To provide an opportunity and a mechanism for CLIA laboratories surveyed by CMS or CMS' agent to express their satisfaction and concerns about the CLIA survey process.

None
None


No

1
IC Title Form No. Form Name
Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777 CMS-668B

  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 10,500 11,250 0 0 -750 0
Annual Time Burden (Hours) 2,625 2,813 0 0 -188 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.
05/15/2006


© 2024 OMB.report | Privacy Policy