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Product Form (Includes Infusion, HLA, and Infectious Disease Marker Inserts)
Stem Cell Therapeutic Outcomes Database
OMB: 0915-0310
IC ID: 237623
OMB.report
HHS/HSA
OMB 0915-0310
ICR 202004-0915-001
IC 237623
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:
2024-07-25 - No material or nonsubstantive change to a currently approved collection
2024-05-15 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 3
Product Form (Includes Infusion, HLA, and Infectious Disease Marker Inserts)
Form
3 ProductForm-Infusion, HLA, Infectious Disease Marker.pdf
FormProductForm-Infusion, HLA, Infectious Disease Marker.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Product Form (Includes Infusion, HLA, and Infectious Disease Marker Inserts)
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
3
ProductForm-Infusion, HLA, Infectious Disease Marker.pdf
FormProductForm-Infusion, HLA, Infectious Disease Marker.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
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:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
9,000
0
0
0
0
9,000
Annual IC Time Burden (Hours)
9,000
0
0
0
0
9,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
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.