Information Collection

Att 3a_50.34 Form_V3.3.3

IC 243434 under ICR 202009-0920-001 · OMB 0920-1309.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 50.34_v3.3.3 Att 3a_50.34 Form_V3.3.3	Form
CDC 50.34_v3.3.3 CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORGAN Att 3a 50.34 Form_v3.3.3.pdf	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 50.34_v3.3.3	CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORGAN	Att 3a 50.34 Form_v3.3.3.pdf		No		Fillable Printable

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 42464

Number of Respondents: 98

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	18,914	18,914
Annual IC Time Burden (Hours)	1,576	1,576
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.