Information Collection

Hemophilia Treatment Center Factor Replacement Data Sheet

IC 181184 under ICR 200707-0915-002 · OMB 0915-0312.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Data Sheet Hemophilia Treatment Center Factor Replacement Data Sheet	Form
Data Sheet Data Sheet FINALFRPdatasheet-06-22-2007.doc	Form
FINALFRPDataSheetInstructions-06-22-2007.doc Instructions	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Data Sheet	Data Sheet	FINALFRPdatasheet-06-22-2007.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 68

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	68	68
Annual IC Time Burden (Hours)	2,040	2,040
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions	FINALFRPDataSheetInstructions-06-22-2007.doc	07/06/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.