Information Collection

Hospital -Based Laboratories

IC 204573 under ICR 201210-0955-001 · OMB 0955-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0014 can be found here:

Documents and Forms

Document Name Document Type
Attachment A - Questionnaire & Letters - Hospital Labs.pdf Other-Evaluation

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospital -Based Laboratories	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Evaluation			Attachment A - Questionnaire & Letters - Hospital Labs.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,729	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,729	2,729
Annual IC Time Burden (Hours)	910	910
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.