Information Collection

57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction

IC 222895 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 57.308 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form
57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Re 57.308_HV AR-Allergic_BLANK.docx Form
57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Re 57.308_HV AR-Allergic_BLANK.docx Form
CDC 57.308 Hemovigilance Module Adverse Reaction Allergic Transfusi 57.308_HV-AR-Allergic_OMB.docx Form
CDC 57.308 Hemovigilance Module Adverse Reaction Allergic Transfusi 57.308_HV-AR-Allergic_OMB.docx Form
57.308_HV-AR-Allergic_OMB.docx Hemovigilance Module Adverse Reaction Allergic Transfusion Reaction (with revised GISAB questions in tracked changes) IC Document
57.308_HV-AR-Allergic_OMB.docx Hemovigilance Module Adverse Reaction Allergic Transfusion Reaction (with revised GISAB questions in tracked changes) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	Agency IC Tracking Number:	0920-0666

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	57.308	Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	57.308_HV AR-Allergic_BLANK.docx		Yes	Yes	Fillable Printable
Form	CDC 57.308	Hemovigilance Module Adverse Reaction Allergic Transfusion Reaction (with revised GISAB questions)	57.308_HV-AR-Allergic_OMB.docx		Yes	Yes	Fillable Fileable

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,000	0	2,000
Annual IC Time Burden (Hours)	700	33	667
Annual IC Cost Burden (Dollars)	0	-23,326	23,326

Documents for IC

Title	Document	Date Uploaded
Hemovigilance Module Adverse Reaction Allergic Transfusion Reaction (with revised GISAB questions in tracked changes)	57.308_HV-AR-Allergic_OMB.docx	04/25/2023

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