HBV and HCV Risk Factor

HIV Study in Blood Donors from Five Chinese Regions (NHLBI)

Documents and Forms

Document Name Document Type
Form 1.2 HBV and HCV Risk Factor Form and Instruction
1.2 HBV HCV Attachment 1.2_HBV&HCV Qx.doc Form and Instruction
Attachment 2.3_Consent HBV.doc Attachment 2 IC Document

Information Collection (IC) Details

IC Title:	HBV and HCV Risk Factor	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 and Instruction	1.2	HBV HCV	Attachment 1.2_HBV&HCV Qx.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,870	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,870	2,870
Annual IC Time Burden (Hours)	-947	947
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 2	Attachment 2.3_Consent HBV.doc	10/22/2008

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