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Federal forms, ICRs, and supporting documents

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

IC 8201 under ICR 202402-0938-011 · OMB 0938-0599.

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CLIA Budget Workload Reports and Supporting Regulations Contained in 42 CFR 493.1-.2001 (CMS-102, CMS-105)
 
No Modified
 
Voluntary
 
42 CFR 493.1-.2001

Document Type Form No. Form Name Instrument File URL 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

Health Health Care Services

 

50 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50 0 0 0 50 0
Annual IC Time Burden (Hours) 1,700 0 0 0 1,700 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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