VITAL-EQA Data Submission Form (Clinical Lab)

NCEH DLS Laboratory Quality Assurance Programs

Documents and Forms

Document Name Document Type
VITAL-EQA Data Submission Form (Clinical Lab) Form
Data Submission Form Folate Att 3f-II. VITAL-EQA DataReturn_ FA.xlsx Form
Data Submission Form Folate Att 3f-II. VITAL-EQA DataReturn_ FA.xlsx Form
Data Submission Form Vit B12 Att 3f-II. VITAL-EQA DataReturn_B12.xlsx Form
Data Submission Form Vit B12 Att 3f-II. VITAL-EQA DataReturn_B12.xlsx Form
Data Submission Form CRP Att 3f-II. VITAL-EQA DataReturn_CRP.xlsx Form
Data Submission Form CRP Att 3f-II. VITAL-EQA DataReturn_CRP.xlsx Form
Data Submission Form Ferritin Att 3f-II. VITAL-EQA DataReturn_Fe.xlsx Form
Data Submission Form Ferritin Att 3f-II. VITAL-EQA DataReturn_Fe.xlsx Form
Data Submission Form sTfR Att 3f-II. VITAL-EQA DataReturn_sTfR.xlsx Form
Data Submission Form sTfR Att 3f-II. VITAL-EQA DataReturn_sTfR.xlsx Form
Data Submission Form Vit D Att 3f-II. VITAL-EQA DataReturn_VD.xlsx Form
Data Submission Form Vit D Att 3f-II. VITAL-EQA DataReturn_VD.xlsx Form
Data Submission Form Vit A Att 3f-II. VITAL-EQA DataReturn_VitA.xlsx Form
Data Submission Form Vit A Att 3f-II. VITAL-EQA DataReturn_VitA.xlsx Form

Information Collection (IC) Details

IC Title:	VITAL-EQA 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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Data Submission Form Folate	Att 3f-II. VITAL-EQA DataReturn_ FA.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	Data Submission Form Vit B12	Att 3f-II. VITAL-EQA DataReturn_B12.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	Data Submission Form CRP	Att 3f-II. VITAL-EQA DataReturn_CRP.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	Data Submission Form Ferritin	Att 3f-II. VITAL-EQA DataReturn_Fe.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	Data Submission Form sTfR	Att 3f-II. VITAL-EQA DataReturn_sTfR.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	Data Submission Form Vit D	Att 3f-II. VITAL-EQA DataReturn_VD.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	Data Submission Form Vit A	Att 3f-II. VITAL-EQA DataReturn_VitA.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	22	22
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.