57.303 Hemovigilance Module Monthly Reporting Denominators

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators Form
CDC 57.303 Hemovigilance Module Monthly Reporting Denominators 57.303_HV Monthly Reporting Denoms_BLANK.DOCX Form
Att G.2_ Biovigilance Component.pdf Att G.2_NHSN Biovigilance Component: Hemovigilance Module Surveillance Protocol IC Document

Information Collection (IC) Details

IC Title:	57.303 Hemovigilance Module Monthly Reporting Denominators	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form	CDC 57.303	Hemovigilance Module Monthly Reporting Denominators	57.303_HV Monthly Reporting Denoms_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	198,840	198,840

Documents for IC

Title	Document	Date Uploaded
Att G.2_NHSN Biovigilance Component: Hemovigilance Module Surveillance Protocol	Att G.2_ Biovigilance Component.pdf	08/28/2014

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