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57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction
[NCEZID] The National Healthcare Safety Network (NHSN)
OMB: 0920-0666
IC ID: 222906
OMB.report
HHS/CDC
OMB 0920-0666
ICR 202310-0920-013
IC 222906
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:
2024-02-28 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form CDC 57.319
57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction
Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea
57.319_HV AR-UNK_BLANK.docx
Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea
57.319_HV AR-UNK_BLANK.docx
Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea
57.319_HV-AR-UNK_OMB.docx
Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea
57.319_HV-AR-UNK_OMB.docx
Form
57.319_HV-AR-UNK_OMB.docx
Hemovigilance Adverse Reaction - Unknown Transfusion Reaction (with modified GISAB questions in tracked changes)
IC Document
57.319_HV-AR-UNK_OMB.docx
Hemovigilance Adverse Reaction - Unknown Transfusion Reaction (with modified GISAB questions in tracked changes)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
57.319 Hemovigilance Adverse Reaction - Unknown 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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CDC 57.319
Hemovigilance Adverse Reaction - Unknown Transfusion Reaction
57.319_HV AR-UNK_BLANK.docx
Yes
Yes
Fillable Printable
Form
CDC 57.319
Hemovigilance Adverse Reaction - Unknown Transfusion Reaction (with modified GISAB questions)
57.319_HV-AR-UNK_OMB.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
500
0
0
0
0
500
Annual IC Time Burden (Hours)
175
0
0
0
0
175
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Hemovigilance Adverse Reaction - Unknown Transfusion Reaction (with modified GISAB questions in tracked changes)
57.319_HV-AR-UNK_OMB.docx
04/25/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.