View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0544	ICR Reference No: 199306-0938-015
Status: Historical Active	Previous ICR Reference No: 199301-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: SURVEY REPORT FORM (CLIA)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/24/1993
	Date Received in OIRA: 06/28/1993
Terms of Clearance: Approved for use through 1/94 under the condition that the next submis sion for OMB review includes all current guidelines and clarifying memoranda reflecting policies to be incorporated into the guidelines and/or forms at a later date. This action reinstates and extends approval of the HCFA-1557 and guidelines covered by the last OMB actio dated 8/21/92. In the future, HCFA always should submit supporting instructions with Forms for PRA review, so OMB reasonably can evaluate the information collection requirements pursuant to 5 CFR 1320.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/1994	01/31/1994
Responses	31,200	0	0
Time Burden (Hours)	16,848	0	0
Cost Burden (Dollars)	0	0	0

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