Information Collection

Laboratory Medicine Best Practices Project Data Submission Form

IC 192353 under ICR 201204-0920-003 · OMB 0920-0848.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0848 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C LMBP Data Collection -Submission Form.doc	Instruction
Attachment 2 LMBP Data Instructions.docx	Instruction
1 LMBP Quality Improvement (QI) Data Submission Form Attachment 1 Revised Data Submission Form.doc	Form
Attachment D_Draft LMBP Evidence Summary Table Format .doc Attachment D_Draft LMBP Evidence Summary Table Format	IC Document

IC Title:

Laboratory Medicine Best Practices Project Data Submission Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment C LMBP Data Collection -Submission Form.doc	Yes	Yes	Fillable Printable
Instruction			Attachment 2 LMBP Data Instructions.docx	Yes	No	Paper Only
Form	1	LMBP Quality Improvement (QI) Data Submission Form	Attachment 1 Revised Data Submission Form.doc	No	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 20

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D_Draft LMBP Evidence Summary Table Format	Attachment D_Draft LMBP Evidence Summary Table Format .doc	11/20/2009

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