Information Collection

Laboratory Application

IC 193836 under ICR 202303-0930-002 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0930-0158 CCF_Urin Laboratory Application	Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Application_Jan2020_ 0930-0158 CCF_Tab E_Urine_LAB_Application_Jan2020_FINAL.pdf	Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Application_Jan2020_ 0930-0158 CCF_Tab E_Urine_LAB_Application_Jan2020_FINAL.pdf	Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Info_Checklist 0930-0158 CCF_Tab F_Urine_LAB_Info_Checklist_AthruC_Jan2020_Final.pdf	Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Info_Checklist 0930-0158 CCF_Tab F_Urine_LAB_Info_Checklist_AthruC_Jan2020_Final.pdf	Form and Instruction
0930-0158 CCF_Tab I_IITF_Application_Jan2020.pdf 0930-0158 CCF_Tab I_IITF_Application_Jan2020	IC Document
0930-0158 CCF_Tab I_IITF_Application_Jan2020.pdf 0930-0158 CCF_Tab I_IITF_Application_Jan2020	IC Document

IC Title:

Laboratory Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	0930-0158 CCF_Urine_LAB_Application_Jan2020_	0930-0158 CCF_Urine_LAB_Application_Jan2020_	0930-0158 CCF_Tab E_Urine_LAB_Application_Jan2020_FINAL.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0930-0158 CCF_Urine_LAB_Info_Checklist	0930-0158 CCF_Urine_LAB_Info_Checklist	0930-0158 CCF_Tab F_Urine_LAB_Info_Checklist_AthruC_Jan2020_Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10	5	5
Annual IC Time Burden (Hours)	30	15	15
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0930-0158 CCF_Tab I_IITF_Application_Jan2020	0930-0158 CCF_Tab I_IITF_Application_Jan2020.pdf	03/21/2023

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