Information Collection

Laboratory Certification (State & Local)

IC 189179 under ICR 201801-2040-002 · OMB 2040-0246.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TBD Laboratory Certification (State & Local)	Form and Instruction
TBD Checklist A - Method 1623_1623.1 Audit Package and Data Checklist A - Method 1623_1623.1 Audit Package and Data Review.pdf	Form and Instruction
TBD Checklist B - Laboratory SOP Review Checklist B - Laboratory SOP Review.pdf	Form and Instruction
TBD Checklist C - Method 1623_1623.1 Technical Review_Sample Checklist C - Method 1623_1623.1 Technical Review_Sample Processing and Microscopy.pdf	Form and Instruction
TBD Cryptosporidium Laboratory Audit Application Form Cryptosporidium Laboratory Audit Application Form.pdf	Form
TBD Application Package for Assessment of Crypto Lab QA. Application Package for Assessment of Crypto Lab QA.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 40 CFR 141.705(a) and 142.10(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TBD	Checklist A - Method 1623_1623.1 Audit Package and Data Review	Checklist A - Method 1623_1623.1 Audit Package and Data Review.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	TBD	Checklist B - Laboratory SOP Review	Checklist B - Laboratory SOP Review.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	TBD	Checklist C - Method 1623_1623.1 Technical Review_Sample Processing and Microscopy	Checklist C - Method 1623_1623.1 Technical Review_Sample Processing and Microscopy.pdf	Yes	Yes	Fillable Fileable
Form	TBD	Cryptosporidium Laboratory Audit Application Form	Cryptosporidium Laboratory Audit Application Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	TBD	Application Package for Assessment of Crypto Lab QA.	Application Package for Assessment of Crypto Lab QA.pdf	Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 0

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	69	39	30
Annual IC Time Burden (Hours)	1,350	-986	2,336
Annual IC Cost Burden (Dollars)	178,058	-18,646	196,704

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.