View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0544	ICR Reference No: 199610-0938-009
Status: Historical Active	Previous ICR Reference No: 199502-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Survey Report Form (CLIA)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/06/1997
	Date Received in OIRA: 10/24/1996
Terms of Clearance: Approved without change for use through 1/2000 under the condi- tion that HCFA promptly submits these forms and instructions for PRA review upon finalization of new CLIA regulatory amendments. In addition, HCFA immediately must incorporate the new disclosure statements into the forms/instructions as mandated by the Paper- work Reduction Act of 1995. For the public record, HCFA must submit to OMB the forms/instructions.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2000	01/31/2000	12/31/1996
Responses	15,112	0	30,225
Time Burden (Hours)	16,322	0	16,322
Cost Burden (Dollars)	0	0	0

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