CLIA Budget Workload Reports and Supporting Regulations Contained in 42 CFR 493.1-.2001 (CMS-102, CMS-105)

CLIA Budget Workload Reports and Supporting Regulations (CMS-102, CMS-105)

Documents and Forms

Document Name Document Type
Form CMS-102 CLIA Budget Workload Reports and Supporting Regulations Contained in 42 CFR 493.1-.2001 (CMS-102, CMS-105) Form
som107c06 - CMS-102 CMS-105 instructions.pdf Instruction
som107c06 - CMS-102 CMS-105 instructions.pdf Instruction
CMS-102 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM BUDGE CMS-102- Instrument.xlsx Form
CMS-102 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM BUDGE CMS-102- Instrument.xlsx Form
CMS-105 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM PLANN CMS-105- Instrument.xlsx Form
CMS-105 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM PLANN CMS-105- Instrument.xlsx Form

Information Collection (IC) Details

IC Title:	CLIA Budget Workload Reports and Supporting Regulations Contained in 42 CFR 493.1-.2001 (CMS-102, CMS-105)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 493.1-.2001

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-102	CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM BUDGET/EXPENDITURE REPORT	CMS-102- Instrument.xlsx	Yes	Yes	Fillable Fileable
Form	CMS-105	CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM PLANNED WORKLOAD REPORT	CMS-105- Instrument.xlsx	Yes	Yes	Fillable Fileable
Instruction			som107c06 - CMS-102 CMS-105 instructions.pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	1,700	1,700
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.