View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	57.301 Hemovigilance Module Monthly Reporting Plan	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	CDC 57.301	Hemovigilance Module Monthly Reporting Plan	57.301_HV Monthly Reporting Plan_BLANK.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	6,000	0	0	0	0	6,000
Annual IC Time Burden (Hours)	100	0	0	0	0	100
Annual IC Cost Burden (Dollars)	3,499	0	0	0	0	3,499

Documents for IC

Title	Document	Date Uploaded
Att G3_Bioviligance Component	Att G3_Biovigilance Component.pdf	09/09/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.