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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.