State, Local, or Tribal Governments - Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777

Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777 (CMS-668B)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0653 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-668B State, Local, or Tribal Governments - Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777 Form and Instruction
CMS-668B Post Clinical Laboratory Survey Questionnaire CMS668B.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	State, Local, or Tribal Governments - Post Cinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 483.1773, and 493.1777	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	CMS-668B	Post Clinical Laboratory Survey Questionnaire	CMS668B.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,290	Number of Respondents for Small Entity: 294

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	645	645
Annual IC Time Burden (Hours)	161	161
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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