Information Collection

LSP Enrollment Section on Data Submission Form (Clinical Lab)

IC 255887 under ICR 202602-0920-004 · OMB 0920-1389.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
LSP Enrollment Section on Data Submission Form LSP Enrollment Section on Data Submission Form (Clinical Lab)	Form
LSP Enrollment Section on Data Submission Form Att 3b LSP Enroll&DataReturnIncidentForm_08-2025.pdf	Form

IC Title:

Agency IC Tracking Number:

0920-1389

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	60	20	40
Annual IC Time Burden (Hours)	25	8	17
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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