OMB control number

Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations (CMS-1557)

OMB 0938-0544 · HHS/CMS.

OMB 0938-0544

This survey form is an instrument used by the State agency to record data collected in order to determine compliance with CLIA. This information is needed for laboratory certification and recertification.

The latest form for Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations (CMS-1557) expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-1557 Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001 Form and Instruction
Form CMS-1557 Federal Government - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001 Form and Instruction
Form CMS-1557 State, Local, or Tribal Governments - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001 Form and Instruction
CMS-1557 Supporting Statement. 7-2-2021.docx Supporting Statement A
Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001 Form and Instruction
Federal Government - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001 Form and Instruction
State, Local, or Tribal Governments - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001 Form and Instruction

All Historical Document Collections

202111-0938-003 Approved without change	Extension without change of a currently approved collection	2021-11-02
201805-0938-007 Approved without change	Extension without change of a currently approved collection	2018-05-15
201503-0938-006 Approved with change	Extension without change of a currently approved collection	2015-03-13
201204-0938-007 Approved without change	Extension without change of a currently approved collection	2012-04-30
200903-0938-011 Approved without change	Extension without change of a currently approved collection	2009-03-30
200601-0938-010 Approved without change	Extension without change of a currently approved collection	2006-01-26
200212-0938-009 Approved without change	Extension without change of a currently approved collection	2002-12-17
199911-0938-006 Approved without change	Extension without change of a currently approved collection	1999-11-12
199610-0938-009 Approved without change	Revision of a currently approved collection	1996-10-24
199502-0938-005 Approved without change	Extension without change of a currently approved collection	1995-02-21
199401-0938-007 Approved without change	Revision of a currently approved collection	1994-01-31
199306-0938-015 Approved without change	Reinstatement with change of a previously approved collection	1993-06-28
199301-0938-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1993-01-27
199207-0938-001 Approved without change	Reinstatement with change of a previously approved collection	1992-07-06
199009-0938-011 Approved without change	Reinstatement with change of a previously approved collection	1990-09-25
198904-0938-008 Approved without change	New collection (Request for a new OMB Control Number)	1989-04-06

OMB Details

Private Sector - Survey Report Form Clinical Laboratory Improvement Amendments (CLIA) and supporting regulations in 42 CFR 493.1-493.2001

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-1557

Survey Report Form (CLIA)

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.