Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001

ICR 201204-0938-007

OMB: 0938-0544

Federal Form Document

ICR Details
0938-0544 201204-0938-007
Historical Active 200903-0938-011
HHS/CMS
Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001
Extension without change of a currently approved collection   No
Regular
Approved without change 06/08/2012
Retrieve Notice of Action (NOA) 04/30/2012
  Inventory as of this Action Requested Previously Approved
06/30/2015 36 Months From Approved 06/30/2012
10,244 0 10,500
5,123 0 5,248
0 0 0

This survey form is an instrument used by the State agency to record data collected in order to determine compliance with CLIA. This information is needed for laboratory certification and recertification.

PL: Pub.L. 100 - 578 353 Name of Law: Certification of Laboratories
  
None

Not associated with rulemaking

  77 FR 6124 02/07/2012
77 FR 23265 04/18/2012
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10,244 10,500 0 0 -256 0
Annual Time Burden (Hours) 5,123 5,248 0 0 -125 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$71,221
No
No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/30/2012


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