Information Collection

State, Local, or Tribal Governments - Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777

IC 202097 under ICR 201508-0938-008 · OMB 0938-0653.

Documents and Forms

Document Name Document Type
Form CMS-668B State, Local, or Tribal Governments - Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777 Form and Instruction
CMS-668B Post Clinical Laboratory Survey Questionnaire CMS668B.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Local, or Tribal Governments - Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	CMS-668B	Post Clinical Laboratory Survey Questionnaire	CMS668B.pdf		Yes	No	Fillable Fileable

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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	660	15	645
Annual IC Time Burden (Hours)	165	4	161
Annual IC Cost Burden (Dollars)	0	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.