Information Collection

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

IC 7865 under ICR 202106-0938-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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) 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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.