Information Collection

57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction

IC 222894 under ICR 202310-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.307 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	Form
57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfu 57.307_HV AR-AHTR_BLANK.docx	Form
57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfu 57.307_HV AR-AHTR_BLANK.docx	Form
CDC 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfu 57.307_HV-AR-AHTR_OMB.docx	Form
CDC 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfu 57.307_HV-AR-AHTR_OMB.docx	Form
57.307_HV-AR-AHTR_OMB.docx Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction (with revised GISAB questions in tracked changes)	IC Document
57.307_HV-AR-AHTR_OMB.docx Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction (with revised GISAB questions in tracked changes)	IC Document

IC Title:

57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction

Agency IC Tracking Number:

0920-0666

Is this a Common Form? No

IC Status: Unchanged

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	57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	57.307_HV AR-AHTR_BLANK.docx		Yes	Yes	Fillable Printable
Form	CDC 57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction (with revised GISAB questions)	57.307_HV-AR-AHTR_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: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	700	700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction (with revised GISAB questions in tracked changes)	57.307_HV-AR-AHTR_OMB.docx	04/25/2023

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