OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

CLIA Budget Workload Reports and Supporting Regulations (CMS-102, CMS-105)

OMB 0938-0599 · HHS/CMS.

OMB 0938-0599

Information collected is used by CMS to determine the amount of Federal Reimbursement for compliance surveys. Use of the information includes program evaluation, audit, budget formulation and budget approval.

The latest form for CLIA Budget Workload Reports and Supporting Regulations (CMS-102, CMS-105) expires 2027-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supporting Statement A
All Historical Document Collections
Approved without change
 Reinstatement without change of a previously approved collection 2024-02-28
Approved with change
 Reinstatement with change of a previously approved collection 2018-03-14
Approved without change
 Extension without change of a currently approved collection 2014-04-22
Approved without change
 Extension without change of a currently approved collection 2011-03-20
Approved without change
 Extension without change of a currently approved collection 2007-11-21
Approved without change
 Extension without change of a currently approved collection 2004-08-20
Approved without change
 Extension without change of a currently approved collection 2001-09-25
Approved without change
 Extension without change of a currently approved collection 1998-05-19
Approved with change
 No material or nonsubstantive change to a currently approved collection 1997-02-28
Approved without change
 Reinstatement without change of a previously approved collection 1995-04-25
Approved without change
 New collection (Request for a new OMB Control Number) 1991-12-26