Information Collection

Laboratory Recordkeeping

IC 193838 under ICR 201007-0930-002 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Document Name Document Type
Form Urine Lab Appl. Fo Laboratory Recordkeeping Form and Instruction
Urine Lab Appl. Fo Urine Lab Appl. Form Attachment E.pdf Form and Instruction
Urine Lab Info Che Urine Lab Info Checklist Form Attachment F.pdf Form and Instruction
Urine IITF Appl. F Urine IITF Appl. Form Attachment G.pdf Form and Instruction
Urine IITF Info Ch Urine IITF Info Checklist Form Attachment H.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Laboratory Recordkeeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Urine Lab Appl. Form	Urine Lab Appl. Form	Attachment E.pdf	Yes	Yes	Paper Only
Form and Instruction	Urine Lab Info Checklist Form	Urine Lab Info Checklist Form	Attachment F.pdf	Yes	Yes	Paper Only
Form and Instruction	Urine IITF Appl. Form	Urine IITF Appl. Form	Attachment G.pdf	Yes	Yes	Paper Only
Form and Instruction	Urine IITF Info Checklist Form	Urine IITF Info Checklist Form	Attachment H.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	12,500	12,500
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.