Laboratory Personnel Report (CLIA) and Supporting Regulations (CMS-209)

OMB 0938-0151

This form is used by the State agency to determine a laboratory's compliance with personnel qualifications under CLIA. This information is needed for a laboratory's CLIA certification and recertification.

The latest form for Laboratory Personnel Report (CLIA) and Supporting Regulations (CMS-209) expires 2021-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-209 Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1 - 493.2001 Form and Instruction
Form CMS-209 Laboratory Personnel Report (CMS-209) Form and Instruction
Form CMS-209 Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001 (CMS-209) Form and Instruction
CMS-209 Supporting Statement A 3-3-21.docx Supporting Statement A
Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1 - 493.2001 Form and Instruction
Laboratory Personnel Report (CMS-209) Form and Instruction
Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001 (CMS-209) Form and Instruction

All Historical Document Collections

202106-0938-009 Approved without change	Revision of a currently approved collection	2021-06-22
201803-0938-006 Approved with change	Revision of a currently approved collection	2018-03-27
201502-0938-006 Approved with change	Extension without change of a currently approved collection	2015-02-23
201201-0938-005 Approved without change	Extension without change of a currently approved collection	2012-01-31
200808-0938-001 Approved without change	Extension without change of a currently approved collection	2008-08-08
200505-0938-005 Approved with change	Extension without change of a currently approved collection	2005-05-16
200302-0938-008 Approved with change	Extension without change of a currently approved collection	2003-02-25
199912-0938-008 Approved without change	Extension without change of a currently approved collection	1999-12-27
199610-0938-007 Approved without change	Extension without change of a currently approved collection	1996-10-29
199410-0938-016 Approved without change	Revision of a currently approved collection	1994-10-31
199310-0938-011 Approved without change	Reinstatement with change of a previously approved collection	1993-10-04
199207-0938-008 Approved without change	Reinstatement with change of a previously approved collection	1992-07-13
199103-0938-012 Approved without change	Reinstatement with change of a previously approved collection	1991-03-14
199003-0938-003 Approved without change	Reinstatement with change of a previously approved collection	1990-03-12
198805-0938-002 Approved without change	Reinstatement with change of a previously approved collection	1988-05-26
198502-0938-004 Approved without change	Extension without change of a currently approved collection	1985-02-14
198404-0938-002 Approved without change	Revision of a currently approved collection	1984-04-13
198305-0938-008 Approved with change	No material or nonsubstantive change to a currently approved collection	1983-05-18
198204-0938-013 Approved without change	Extension without change of a currently approved collection	1982-04-12
198102-0938-004 Approved without change	New collection (Request for a new OMB Control Number)	1981-02-05

OMB Details

Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1 - 493.2001

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-209

Laboratory Personnel Report (CLIA)

Fillable Printable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.