CDCModel Performance Evaluation Program (MPEP) Laboratory Change Form

CDC Model Performance Evaluation Program (MPEP) for Retroviral and AIDS-Related Testing

Documents and Forms

Document Name Document Type
Attachment 8 HIICF_domestic.doc Other-Laboratory Change Form
Attachment 8 HIICF_earlyShip.doc Laboratory Change Form Foreign Countries IC Document

Information Collection (IC) Details

IC Title:	CDCModel Performance Evaluation Program (MPEP) Laboratory Change Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Laboratory Change Form			Attachment 8 HIICF_domestic.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Laboratory Change Form Foreign Countries	Attachment 8 HIICF_earlyShip.doc	08/07/2007

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