Information Collection

Att 3a_ 50.34 Form_v4.2.3

IC 243431 under ICR 202308-0920-008 · OMB 0920-1309.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 50.34 Att 3a_ 50.34 Form_v4.2.3	Form
CDC 50.34 CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORIGIN CDC Specimen Submission 50.34 Form v4.2.3.pdf	Form
CDC 50.34 CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORIGIN CDC Specimen Submission 50.34 Form v4.2.3.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	CDC 50.34	CDC SPECIMEN SUBMISSION FORM: SPECIMENS OF HUMAN ORIGIN	CDC Specimen Submission 50.34 Form v4.2.3.pdf		No		Fillable Fileable

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 42484

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-6,000	6,000
Annual IC Time Burden (Hours)	-500	500
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.