Information Collection

Rapid Response Survey for Hepatitis E Virus-Exposure Blood Donors

IC 218411 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⚠️ Notice: This information collection may be referencing outdated material.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 Hep E-Virus 9-30-2015.docx	Other-Survey
Consent Form - Hep E Virus Exposure.doc Consent Form	IC Document
OMB Justification Memo for Hepatitis E Virus-Exposure Rapid Survey of Blood Donors 0500 9-30-2015 .docx OMB Justification Memo for Generic Clearance of Rapid Response Survey	IC Document

IC Title:

Rapid Response Survey for Hepatitis E Virus-Exposure Blood Donors

Agency IC Tracking Number:

CBER

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-Survey			Questionnaire 0500 Hep E-Virus 9-30-2015.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
Consent Form	Consent Form - Hep E Virus Exposure.doc	09/30/2015
OMB Justification Memo for Generic Clearance of Rapid Response Survey	OMB Justification Memo for Hepatitis E Virus-Exposure Rapid Survey of Blood Donors 0500 9-30-2015 .docx	09/30/2015

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