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

Laboratory Personnel Report (CLIA) and Supporting Regulations (CMS-209)

Documents and Forms

Document Name Document Type
Form CMS-209 Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1 - 493.2001 Form and Instruction
CMS-209 Laboratory Personnel Report (CLIA) CMS-209-508-2021 enabled.Final.pdf Form and Instruction
2020.CMS-209.Revision.crosswalk.pdf crosswalk IC Document

Information Collection (IC) Details

IC Title:	Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1 - 493.2001	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-209	Laboratory Personnel Report (CLIA)	CMS-209-508-2021 enabled.Final.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19,163	Number of Respondents for Small Entity: 8,905

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,582	677	8,905
Annual IC Time Burden (Hours)	4,791	339	4,452
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
crosswalk	2020.CMS-209.Revision.crosswalk.pdf	06/22/2021

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