Information Collection

Babesia-Exposure Rapid Survey of Blood Donors

IC 217019 under ICR 201404-0910-010 · OMB 0910-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Document Name Document Type
QUESTIONNAIRE 0500 BABESIA EXPOSURE 6-12-2015.docx Other-Survey
GENERAL PROTOCOL 6-18-15.doc Other-Consent Form
OMB Justification for generic clearance 0500 for Babesia Exposure 6-12-2015.doc OMB Justification Memo for generic clearance for Babesia Exposure of Blood Donors IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Babesia-Exposure Rapid Survey of Blood Donors	Agency IC Tracking Number:	CDER

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent Form			GENERAL PROTOCOL 6-18-15.doc		Yes	Yes	Fillable Fileable
Other-Survey			QUESTIONNAIRE 0500 BABESIA EXPOSURE 6-12-2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo for generic clearance for Babesia Exposure of Blood Donors	OMB Justification for generic clearance 0500 for Babesia Exposure 6-12-2015.doc	06/12/2015

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