Att 3a_50.34 Form_V4.2.3

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⚠️ Notice: This information collection may be referencing outdated material.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_v4.2.3 Att 3a_50.34 Form_V4.2.3 Form
CDC 50.34_v4.2.3 CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORGAN CDC Specimen Submission 50.34 Form v4.2.3.pdf Form
CDC 50.34_v4.2.3 CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORGAN CDC Specimen Submission 50.34 Form v4.2.3.pdf Form

Information Collection (IC) Details

IC Title:	Att 3a_50.34 Form_V4.2.3	Agency IC Tracking Number:

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	CDC 50.34_v4.2.3	CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORGAN	CDC Specimen Submission 50.34 Form v4.2.3.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 %

	Approved	Previously Approved
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

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.