57.300 Hemovigilance Module Annual Survey -- Acute Care Facility

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form CDC 57.300 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form
CDC 57.300 Hemovigilance Module - Annual Survey 57.300 Hemovigilance Module Annual Survey-Clean Version.docx Form

Information Collection (IC) Details

IC Title:	57.300 Hemovigilance Module Annual Survey -- Acute Care Facility	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	CDC 57.300	Hemovigilance Module - Annual Survey	57.300 Hemovigilance Module Annual Survey-Clean Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 63	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	63	-437	500
Annual IC Time Burden (Hours)	90	-627	717
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.