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Laboratory Application
Mandatory Guidelines for Federal Workplace Drug Testing Programs
OMB: 0930-0158
IC ID: 193836
OMB.report
HHS/SAMHSA
OMB 0930-0158
ICR 202303-0930-002
IC 193836
( )
Documents and Forms
Document Name
Document Type
Form 0930-0158 CCF_Urin
Laboratory Application
Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Application_Jan2020_
0930-0158 CCF_Tab E_Urine_LAB_Application_Jan2020_FINAL.pdf
Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Application_Jan2020_
0930-0158 CCF_Tab E_Urine_LAB_Application_Jan2020_FINAL.pdf
Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Info_Checklist
0930-0158 CCF_Tab F_Urine_LAB_Info_Checklist_AthruC_Jan2020_Final.pdf
Form and Instruction
0930-0158 CCF_Urin 0930-0158 CCF_Urine_LAB_Info_Checklist
0930-0158 CCF_Tab F_Urine_LAB_Info_Checklist_AthruC_Jan2020_Final.pdf
Form and Instruction
0930-0158 CCF_Tab I_IITF_Application_Jan2020.pdf
0930-0158 CCF_Tab I_IITF_Application_Jan2020
IC Document
0930-0158 CCF_Tab I_IITF_Application_Jan2020.pdf
0930-0158 CCF_Tab I_IITF_Application_Jan2020
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Laboratory Application
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
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
0930-0158 CCF_Urine_LAB_Application_Jan2020_
0930-0158 CCF_Urine_LAB_Application_Jan2020_
0930-0158 CCF_Tab E_Urine_LAB_Application_Jan2020_FINAL.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
0930-0158 CCF_Urine_LAB_Info_Checklist
0930-0158 CCF_Urine_LAB_Info_Checklist
0930-0158 CCF_Tab F_Urine_LAB_Info_Checklist_AthruC_Jan2020_Final.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:
10
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
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
10
0
5
0
0
5
Annual IC Time Burden (Hours)
30
0
15
0
0
15
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0930-0158 CCF_Tab I_IITF_Application_Jan2020
0930-0158 CCF_Tab I_IITF_Application_Jan2020.pdf
03/21/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.