Information Collection

Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001 (CMS-209)

IC 186046 under ICR 201201-0938-005 · OMB 0938-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0151 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-209 Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001 (CMS-209) Form and Instruction
CMS-209 Laboratory Personnel Report (CLIA) CMS209.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001 (CMS-209)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 493.1-493.2001

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-209	Laboratory Personnel Report (CLIA)	CMS209.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,290	Number of Respondents for Small Entity: 294

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	810	810
Annual IC Time Burden (Hours)	405	405
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.