Information Collection

57.301 Hemovigilance Module Monthly Reporting Plan

IC 190361 under ICR 201211-0920-005 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.301 57.301 Hemovigilance Module Monthly Reporting Plan	Form
57.301 Hemovigilance Module Monthly Reporting Plan 57.301 HV Monthly Reporting Plan_6.4_OMB.doc	Form
1-10-BV-Protocol.pdf 1-10-BV-Protocol	IC Document
Appendix-A-BV-Protocol.pdf Appendix-A-BV-Protocol	IC Document
Appendix-B-BV-Protocol.pdf Appendix-B-BV-Protocol	IC Document
Appendix-C-BV-Protocol.pdf Appendix-C-BV-Protocol	IC Document
Appendix-D-BV-Protocol.pdf Appendix-D-BV-Protocol	IC Document
Appendix-E-BV-Protocol.pdf Appendix-E-BV-Protocol	IC Document
Appendix-F-BV-Protocol.pdf Appendix-F-BV-Protocol	IC Document
Appendix-G-BV-Protocol.pdf Appendix-G-BV-Protocol	IC Document

IC Title:

57.301 Hemovigilance Module Monthly Reporting Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	57.301	Hemovigilance Module Monthly Reporting Plan	57.301 HV Monthly Reporting Plan_6.4_OMB.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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