Information Collection

57.319_hv Ar-unk_blank

IC 222906 under ICR 202104-0920-002 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material.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 CDC 57.319 57.319_HV AR-UNK_BLANK Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea 57.319_HV AR-UNK_BLANK.docx Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea 57.319_HV AR-UNK_BLANK.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.319_HV AR-UNK_BLANK	Agency IC Tracking Number:	0920-0666

Is this a Common Form? No		IC Status: Unchanged

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 57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	57.319_HV AR-UNK_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	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	5,832	5,832

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.