VITAL-EQA Enrollment Form National (Clinical Lab)

NCEH DLS Laboratory Quality Assurance Programs

Documents and Forms

Document Name Document Type
VITAL-EQA Enrollment Form National (Clinical Lab) Form
VITAL-EQA Enrollment Form National Att 3f-I. VITAL-EQA EnrollForm Natl.xls Form
VITAL-EQA Enrollment Form National Att 3f-I. VITAL-EQA EnrollForm Natl.xls Form

Information Collection (IC) Details

IC Title:	VITAL-EQA Enrollment Form National (Clinical Lab)	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	VITAL-EQA Enrollment Form National	Att 3f-I. VITAL-EQA EnrollForm Natl.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	6	6
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.