Information Collection

Blood Donors

IC 195977 under ICR 201211-0925-006 · OMB 0925-0630.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Blood Donors	Form and Instruction
1 Survey 2674-1 Applicant Informaiton with NIH Commons OMB[1].pdf	Form and Instruction

IC Title:

Blood Donors

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 and Instruction	1	Survey	2674-1 Applicant Informaiton with NIH Commons OMB[1].pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,150	4,150
Annual IC Time Burden (Hours)	2,407	2,407
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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