Product Form (Includes Infusion, HLA, and Infectious Disease Marker Inserts)

Stem Cell Therapeutic Outcomes Database

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:

Documents and Forms

Document Name Document Type
Form 3A Product Form (Includes Infusion, HLA, and Infectious Disease Marker Inserts) Form
3A Infusion - 2006 R5 (current approved for).pdf FORM 3A - 2006 R5 (current approved for).pdf Form
3A Infusion - 2006 R5 (current approved for).pdf FORM 3A - 2006 R5 (current approved for).pdf Form
3B HLA - 2005 R7 (current approved for).pdf FORM 3B - 2005 R7 (current approved for).pdf Form
3B HLA - 2005 R7 (current approved for).pdf FORM 3B - 2005 R7 (current approved for).pdf Form
3C Infectious Disease Markers - 2004 R5 (current approved f FORM 3C - 2004 R5 (current approved for).pdf Form
3C Infectious Disease Markers - 2004 R5 (current approved f FORM 3C - 2004 R5 (current approved for).pdf Form

Information Collection (IC) Details

IC Title:	Product Form (Includes Infusion, HLA, and Infectious Disease Marker Inserts)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3A	Infusion - 2006 R5 (current approved for).pdf	FORM 3A - 2006 R5 (current approved for).pdf	Yes	Yes	Fillable Fileable
Form	3B	HLA - 2005 R7 (current approved for).pdf	FORM 3B - 2005 R7 (current approved for).pdf	Yes	Yes	Fillable Fileable
Form	3C	Infectious Disease Markers - 2004 R5 (current approved for).pdf	FORM 3C - 2004 R5 (current approved for).pdf	Yes	Yes	Fillable Fileable

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	Previously Approved
Annual Number of Responses for this IC	9,000	9,000
Annual IC Time Burden (Hours)	9,000	9,000
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.