Information Collection

Laboratory Application

IC 193836 under ICR 201704-0930-001 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Urine Lab App Form Urine Lab App Form Laboratory Application	Form and Instruction
Form Urine Lab a_b_c Ch Urine Lab a_b_c Checklist Laboratory Application	Form and Instruction
Urine Lab App Form Urine Lab App Form Att D 2017 Urine Lab App form.pdf	Form and Instruction
Urine Lab a_b_c Ch Urine Lab a_b_c Checklist Att E 2017 Urine Lab a_b_c checklist.pdf	Form and Instruction
Att F 2017 IITF App Form.pdf IITF App Form	IC Document
Att G 2017 IITF a_b_c_checklist.pdf IITF a_b_c_Checklist	IC Document

IC Title:

Laboratory Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	Urine Lab App Form				Yes	Yes	Fillable Fileable
Form and Instruction	Urine Lab a_b_c Checklist				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-2	3
Annual IC Time Burden (Hours)	3	-6	9
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IITF App Form		04/27/2017
IITF a_b_c_Checklist		04/27/2017

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

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