Information Collection

CLIA waiver applications and associated records

IC 256591 under ICR 202504-0910-002 · OMB 0910-0607.

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CLIA waiver applications and associated records	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 493

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20	7	13
Annual IC Time Burden (Hours)	80,000	28,000	52,000
Annual IC Cost Burden (Dollars)	540,000	426,250	113,750

Documents for IC

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

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