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

OMB 0938-0544

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 can be found here.

All Historical Document Collections
Approved without change
Extension without change of a currently approved collection 2021-11-02
Approved without change
Extension without change of a currently approved collection 2018-05-15
Approved with change
Extension without change of a currently approved collection 2015-03-13
Approved without change
Extension without change of a currently approved collection 2012-04-30
Approved without change
Extension without change of a currently approved collection 2009-03-30
Approved without change
Extension without change of a currently approved collection 2006-01-26
Approved without change
Extension without change of a currently approved collection 2002-12-17
Approved without change
Extension without change of a currently approved collection 1999-11-12
Approved without change
Revision of a currently approved collection 1996-10-24
Approved without change
Extension without change of a currently approved collection 1995-02-21
Approved without change
Revision of a currently approved collection 1994-01-31
Approved without change
Reinstatement with change of a previously approved collection 1993-06-28
Approved with change
No material or nonsubstantive change to a currently approved collection 1993-01-27
Approved without change
Reinstatement with change of a previously approved collection 1992-07-06
Approved without change
Reinstatement with change of a previously approved collection 1990-09-25
Approved without change
New collection (Request for a new OMB Control Number) 1989-04-06
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

Form CMS-1557Survey Report Form (CLIA)Fillable FileableForm and instruction

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


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