Information Collection

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

IC 186046 under ICR 201502-0938-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-209 Laboratory Personnel Report (CLIA) 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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-209				Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,319

Number of Respondents for Small Entity: 301

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	660	-150	810
Annual IC Time Burden (Hours)	330	-75	405
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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