Information Collection

Lab Values Pretest Induction form

IC 189599 under ICR 201002-0920-004 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form unnumbered Lab Values Pretest Induction form	Form
unnumbered Lab Values Pretest Induction form NAMCS 09-12 OMB ATT K.pdf	Form
NAMCS 09-12 OMB ATT R.pdf Lab Values Pretest Instructions	IC Document

IC Title:

Lab Values Pretest Induction form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	unnumbered	Lab Values Pretest Induction form	NAMCS 09-12 OMB ATT K.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 23

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: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-23	23
Annual IC Time Burden (Hours)	-11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Lab Values Pretest Instructions	NAMCS 09-12 OMB ATT R.pdf	05/11/2009

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