Information Collection

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

IC 222893 under ICR 202412-0920-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

View Information Collection (IC)

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: 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	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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	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.