Information Collection

Enterprise Management Blood System

IC 211331 under ICR 201404-0720-003 · OMB 0720-0057.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PSI_BDMS_HH_Screenshots_20131206.pdf	Other-Instrument Screen Shots
Allogeneic UDHQ.pdf	Other-Blood Donation Record Output Q
Autologous UDHQ.pdf	Other-Blood Donation Record Output Q
Therapeutic UDHQ.pdf	Other-Blood Donation Record Output Q
Compatibility Testing Output Record.pdf	Other-Compatibility Testing Record O
Donor_Disclosure Statement.pdf	Other-Donor On-Line Agency Disclosur

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 200 Series 21 CFR 600 Series 21 CFR 800 Series

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Instrument Screen Shots	PSI_BDMS_HH_Screenshots_20131206.pdf	Yes	Yes	Fillable Fileable
Other-Blood Donation Record Output Qs 1-49	Allogeneic UDHQ.pdf	Yes	Yes	Fillable Fileable
Other-Blood Donation Record Output Qs 101-114	Autologous UDHQ.pdf	Yes	Yes	Fillable Fileable
Other-Blood Donation Record Output Qs 201-206	Therapeutic UDHQ.pdf	Yes	Yes	Fillable Fileable
Other-Compatibility Testing Record Output	Compatibility Testing Output Record.pdf	Yes	Yes	Fillable Fileable
Other-Donor On-Line Agency Disclosure Notice	Donor_Disclosure Statement.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	4,600	4,600
Annual IC Time Burden (Hours)	767	767
Annual IC Cost Burden (Dollars)	12,806	12,806

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.