Information Collection

57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction

IC 222906 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⚠️ Notice: This information collection may be referencing outdated material.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

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 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction-Clean Version.docx Form
CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Rea 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction-Clean Version.docx Form

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: 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 57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction-Clean Version.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	45	-455	500
Annual IC Time Burden (Hours)	15	-160	175
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.