57.318_hv Ar-taco_blank

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⚠️ Notice: This information collection may be referencing outdated material.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 57.318 57.318_HV AR-TACO_BLANK Form
57.318 Hemoviligance Adverse Reaction - Transfusion Associated 57.318_HV AR-TACO_BLANK.DOCX Form

Information Collection (IC) Details

IC Title:	57.318_HV AR-TACO_BLANK	Agency IC Tracking Number:	0920-0666

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	57.318	Hemoviligance Adverse Reaction - Transfusion Associated Circulatory Overload	57.318_HV AR-TACO_BLANK.DOCX		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,000	0	1,000
Annual IC Time Burden (Hours)	333	-84	417
Annual IC Cost Burden (Dollars)	11,663	11,663	0

Documents for IC

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.