Information Collection

57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility

IC 222893 under ICR 202410-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.306 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility	Form
57.306 Hemovigilance Module Annual Survey - Non-acute Care Faci 57.306 Hemovigilance Module Annual Survey - Non-acute care facility-Clean.docx	Form
57.306 Hemovigilance Module Annual Survey - Non-acute Care Faci 57.306 Hemovigilance Module Annual Survey - Non-acute care facility-Clean.docx	Form

IC Title:

57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	57.306	Hemovigilance Module Annual Survey - Non-acute Care Facility	57.306 Hemovigilance Module Annual Survey - Non-acute care facility-Clean.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20	-480	500
Annual IC Time Burden (Hours)	12	-288	300
Annual IC Cost Burden (Dollars)	0	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.