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

Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777 (CMS-668B)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0653 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-668B Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777 Form and Instruction
CMS-668B Post Clinical Laboratory Survey Questionnaire CMS-668B.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	CMS-668B	Post Clinical Laboratory Survey Questionnaire	CMS-668B.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10,500	10,500
Annual IC Time Burden (Hours)	2,625	2,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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