HoSt Data Submission Form (LDT)

NCEH DLS Laboratory Quality Assurance Programs

Documents and Forms

Document Name Document Type
HoSt Data Submission Form (LDT) Form
HoSt Data Submission Form Att 3d. HoStEnroll&DataReturn.pdf Form
HoSt Data Submission Form Att 3d. HoStEnroll&DataReturn.pdf Form

Information Collection (IC) Details

IC Title:	HoSt Data Submission Form (LDT)	Agency IC Tracking Number:	0920-22AW

Is this a Common Form? No		IC Status: New

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	n/a	HoSt Data Submission Form	Att 3d. HoStEnroll&DataReturn.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	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.