Information Collection

Stem Cell Therapeutic Outcomes Database (Product Form)

IC 180281 under ICR 201701-0915-001 · OMB 0915-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Stem Cell Therapeutic Outcomes Database (Product Form)	Form
F2006 Hematopoietic Stem Cell Transplant (HCT) Manual .pdf	Instruction
F2005 Confirmation of HLA Typing Manual.pdf	Instruction
F2004 Infectious Disease Markers. Manual.pdf	Instruction
1 Form_2006_R4+. Hematopoietic Cellular Transplant (HCT) I Form_2006_R4+. Hematopoietic Cellular Transplant (HCT) Infusion.pdf	Form
2 Draft Product Form 2005 HLA r6 Draft Product Form 2005 HLA r6.doc	Form
3 Form_2004_R4+. Infectious Disease Markers Form_2004_R4+. Infectious Disease Markers.pdf	Form

IC Title:

Stem Cell Therapeutic Outcomes Database (Product Form)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Form_2006_R4+. Hematopoietic Cellular Transplant (HCT) Infusion	Form_2006_R4+. Hematopoietic Cellular Transplant (HCT) Infusion.pdf	Yes	Yes	Fillable Fileable
Instruction			F2006 Hematopoietic Stem Cell Transplant (HCT) Manual .pdf	Yes	No	Printable Only
Form	2	Draft Product Form 2005 HLA r6	Draft Product Form 2005 HLA r6.doc	Yes	Yes	Fillable Fileable
Instruction			F2005 Confirmation of HLA Typing Manual.pdf	Yes	No	Printable Only
Form	3	Form_2004_R4+. Infectious Disease Markers	Form_2004_R4+. Infectious Disease Markers.pdf	Yes	Yes	Fillable Fileable
Instruction			F2004 Infectious Disease Markers. Manual.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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: 99 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,600	6,600
Annual IC Time Burden (Hours)	6,600	6,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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