Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001

ICR 200903-0938-011

OMB: 0938-0544

Federal Form Document

ICR Details
0938-0544 200903-0938-011
Historical Active 200601-0938-010
HHS/CMS
Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001
Extension without change of a currently approved collection   No
Regular
Approved without change 06/24/2009
Retrieve Notice of Action (NOA) 03/30/2009
  Inventory as of this Action Requested Previously Approved
06/30/2012 36 Months From Approved 06/30/2009
10,500 0 12,500
5,248 0 6,250
0 0 0

This survey form is an instrument used by the State agency to record data collected in order to determine compliance with CLIA. This information is needed for laboratory certification and recertification.

PL: Pub.L. 100 - 578 353 Name of Law: Certification of Laboratories
  
None

Not associated with rulemaking

  73 FR 64956 10/31/2008
74 FR 11732 03/19/2009
No

  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 12,500 0 0 -2,000 0
Annual Time Burden (Hours) 5,248 6,250 0 0 -1,002 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$72,159
No
No
Uncollected
Uncollected
No
Uncollected
Melissa Musotto 4107866962

  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.
03/30/2009


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