Information Collection

Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire (Nov-Mar)

IC 271080 under ICR 202409-0920-008 · OMB 0920-1442.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire (Nov-Mar)	Form and Instruction
57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Sh E2. 57.109 Blood Culture Bottle Shortage Questionnaire (Nov-Mar)).docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

57.109

Is this a Common Form? No

IC Status: New

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	57.109	Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire (Nov-Mar)	E2. 57.109 Blood Culture Bottle Shortage Questionnaire (Nov-Mar)).docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

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
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	1,167	1,167
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.