Att 3a_ 50.34 Form_v3.3.3

Enterprise Laboratory Information Management System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1309 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 50.34 Att 3a_ 50.34 Form_v3.3.3 Form
CDC 50.34 CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORIGIN Att 3a 50.34 Form_v3.3.3.pdf Form

Information Collection (IC) Details

IC Title:	Att 3a_ 50.34 Form_v3.3.3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 50.34	CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORIGIN	Att 3a 50.34 Form_v3.3.3.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0106 Specimen Handling for Testing and Related Data	FR Citation: 51 FR 42484

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	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.