Requirements for Collection of Data Relating to Prevention of Medical Gas Mix-ups at Health Care Facilities

ICR 200605-0910-002

OMB: 0910-0548

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0910-0548 200605-0910-002
Historical Active 200406-0910-006
HHS/FDA
Requirements for Collection of Data Relating to Prevention of Medical Gas Mix-ups at Health Care Facilities
Extension without change of a currently approved collection   No
Regular
Approved with change 08/04/2006
Retrieve Notice of Action (NOA) 05/30/2006
Please note that this paperwork was already approved, but the questionnaire was not launched due to lack of funding, and the clearance timeline expired. This extension has been granted for 2 years on the following conditions: 1) FDA shall pre-test the questionnaire on a handful of facilities to refine the questions. 2) FDA shall submit the final versions of the questionnaire and the revised letter to the District Offices which includes instructions on how to randomize the sample of facilities that will receive the questionnaire for OMB review and approval prior to the initiating the survey.
  Inventory as of this Action Requested Previously Approved
08/31/2008 36 Months From Approved 08/31/2006
1 0 1
71 0 71
0 0 0

FDA plans to conduct a survey to determine the rate of compliance with its recommendations pertaining to Health Care Facilities and to determine the success rate at preenting medical gas mix-ups from occurring.

None
None


No

1
IC Title Form No. Form Name
Requirements for Collection of Data Relating to Prevention of Medical Gas Mix-ups at Health Care Facilities

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1 1 0 0 0 0
Annual Time Burden (Hours) 71 71 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/30/2006


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