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LSP Enrollment Section on Data Submission Form (Clinical Lab)
NCEH DLS Laboratory Quality Assurance Programs
OMB: 0920-1389
IC ID: 255887
OMB.report
HHS/CDC
OMB 0920-1389
ICR 202209-0920-008
IC 255887
( )
Documents and Forms
Document Name
Document Type
LSP Enrollment Section on Data Submission Form (Clinical Lab)
Form
LSP Enrollment Section on Data Submission Form
Att 3b. LSP Enroll&DataReturnForm.pdf
Form
LSP Enrollment Section on Data Submission Form
Att 3b. LSP Enroll&DataReturnForm.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
LSP Enrollment Section on Data Submission Form (Clinical Lab)
Agency IC Tracking Number:
0920-22AW
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
n/a
LSP Enrollment Section on Data Submission Form
Att 3b. LSP Enroll&DataReturnForm.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:
40
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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
40
0
40
0
0
0
Annual IC Time Burden (Hours)
17
0
17
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
