Defferal Questionnaire

Does Pre-Donation Behavioral Deferral Increase the Safety of the Blood Supply (NHLBI)

Documents and Forms

Document Name Document Type
Deferral Study Consent Form Portuguese.doc Other- Deferral Study Consent Form P
Deferral study Questionnaire Portuguese.rtf Other- Deferral study Questionnaire
Attachment 7_Deferral Informed consent.doc Attachment 7_Deferral Informed consent IC Document

Information Collection (IC) Details

IC Title:	Defferal Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other- Deferral Study Consent Form Portuguese			Deferral Study Consent Form Portuguese.doc		Yes	Yes	Paper Only
Other- Deferral study Questionnaire Portuguese			Deferral study Questionnaire Portuguese.rtf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,860	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,860	4,860
Annual IC Time Burden (Hours)	1,604	1,604
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 7_Deferral Informed consent	Attachment 7_Deferral Informed consent.doc	02/25/2010

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