OMB control number

Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations (CMS-1557)

OMB 0938-0544 · HHS/CMS.

OMB 0938-0544

This survey form is an instrument used by the State agency to record data collected in order to determine compliance with CLIA. This information is needed for laboratory certification and recertification.

The latest form for Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations (CMS-1557) expires 2021-12-31 and is listed under ICR 201805-0938-007.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-1557 Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001	Form and Instruction
Form CMS-1557 Federal Government - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001	Form and Instruction
Form CMS-1557 State, Local, or Tribal Governments - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001	Form and Instruction
CMS-1557 Supporting Statement. 7-2-2021.docx	Supporting Statement A
Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001	Form and Instruction
Federal Government - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001	Form and Instruction
State, Local, or Tribal Governments - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202111-0938-003	Extension without change of a currently approved collection	2021-11-02	Approved without change
201805-0938-007	Extension without change of a currently approved collection	2018-05-15	Approved without change
201503-0938-006	Extension without change of a currently approved collection	2015-03-13	Approved with change
201204-0938-007	Extension without change of a currently approved collection	2012-04-30	Approved without change
200903-0938-011	Extension without change of a currently approved collection	2009-03-30	Approved without change
200601-0938-010	Extension without change of a currently approved collection	2006-01-26	Approved without change
200212-0938-009	Extension without change of a currently approved collection	2002-12-17	Approved without change
199911-0938-006	Extension without change of a currently approved collection	1999-11-12	Approved without change
199610-0938-009	Revision of a currently approved collection	1996-10-24	Approved without change
199502-0938-005	Extension without change of a currently approved collection	1995-02-21	Approved without change
199401-0938-007	Revision of a currently approved collection	1994-01-31	Approved without change
199306-0938-015	Reinstatement with change of a previously approved collection	1993-06-28	Approved without change
199301-0938-006	No material or nonsubstantive change to a currently approved collection	1993-01-27	Approved with change
199207-0938-001	Reinstatement with change of a previously approved collection	1992-07-06	Approved without change
199009-0938-011	Reinstatement with change of a previously approved collection	1990-09-25	Approved without change
198904-0938-008	New collection (Request for a new OMB Control Number)	1989-04-06	Approved without change

OMB Details

Private Sector - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-1557	Survey Report Form (CLIA)	Fillable Fileable	Form and instruction

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