View Information Collection (IC)

View Information Collection (IC)

IC Title:	Laboratory Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Urine Lab App Form	Urine Lab App Form	Att D 2017 Urine Lab App form.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	Urine Lab a_b_c Checklist	Urine Lab a_b_c Checklist	Att E 2017 Urine Lab a_b_c checklist.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1	0	0	-2	0	3
Annual IC Time Burden (Hours)	3	0	0	-6	0	9
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
IITF App Form	Att F 2017 IITF App Form.pdf	04/27/2017
IITF a_b_c_Checklist	Att G 2017 IITF a_b_c_checklist.pdf	04/27/2017

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