Information Collection

57.303 Hemovigilance Module Monthly Reporting Denominators

IC 190363 under ICR 202301-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators	Form
CDC 57.303 Hemovigilance Module Monthly Reporting Denominators 57.303_HV Monthly Reporting Denoms_BLANK.docx	Form
CDC 57.303 Hemovigilance Module Monthly Reporting Denominators 57.303_HV Monthly Reporting Denoms_BLANK_0607.docx	Form and Instruction
57.303_HV Monthly Reporting Denoms_BLANK_0607_tracked.docx Tracked changes for 57.303 to facilitate review and comparison	IC Document

IC Title:

57.303 Hemovigilance Module Monthly Reporting Denominators

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	CDC 57.303	Hemovigilance Module Monthly Reporting Denominators	57.303_HV Monthly Reporting Denoms_BLANK_0607.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,000	0	6,000
Annual IC Time Burden (Hours)	7,000	0	7,000
Annual IC Cost Burden (Dollars)	0	-245,628	245,628

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Tracked changes for 57.303 to facilitate review and comparison	57.303_HV Monthly Reporting Denoms_BLANK_0607_tracked.docx	06/08/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.