Information Collection

57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction

IC 222896 under ICR 202603-0920-006 · OMB 0920-0666.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction	Form
CDC 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Trans 57.309 Hemovigilance Adverse Reaction-Delayed Hemolytic Transfusion Reaction_Clean.docx	Form

IC Title:

Agency IC Tracking Number:

0920-0666

Is this a Common Form? No

IC Status: Removed

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	CDC 57.309				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-18	18
Annual IC Time Burden (Hours)	-6	6
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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