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Clinical Laboratory Improvement Amendments (clia) Application Forms
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA) APPLICATION FORMS
OMB: 0938-0581
IC ID: 114028
OMB.report
HHS/CMS
OMB 0938-0581
ICR 199312-0938-004
IC 114028
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0581 can be found here:
2023-09-27 - Revision of a currently approved collection
2022-03-18 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA) APPLICATION FORMS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA 114
No
No
Form
116
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
80,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
80,000
0
0
-240,000
0
320,000
Annual IC Time Burden (Hours)
440,000
0
0
-386,667
0
826,667
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.