Information Collection

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

IC 237623 under ICR 202207-0915-001 · OMB 0915-0310.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3A	Yes	Yes	Fillable Fileable
Form	3B	Yes	Yes	Fillable Fileable
Form	3C	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 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	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

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.

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