Information Collection

57.303 Hemovigilance Module Monthly Reporting Denominators

IC 190363 under ICR 202502-0920-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators	Form and Instruction
Form CDC 57.303 Hemovigilance Module Monthly Reporting Denominators 57.303 Hemovigilance Module Monthly Reporting Denominators	Form and Instruction
CDC 57.303 Hemovigilance Module Monthly Reporting Denominators 57.303 Hemovigilance Module Monthly Reporting Denominators.docx	Form and Instruction
CDC 57.303 Hemovigilance Module Monthly Reporting Denominators 57.303 Hemovigilance Module Monthly Reporting Denominators.docx	Form and Instruction

IC Title:

57.303 Hemovigilance Module Monthly Reporting Denominators

Agency IC Tracking Number:

0920-0666

Is this a Common Form? No

IC Status: Unchanged

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	CDC 57.303				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 102

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,224	1,224
Annual IC Time Burden (Hours)	1,428	1,428
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.

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