Enterprise Management Blood System

Enterprise Blood Management System (EBMS)

Documents and Forms

Document Name Document Type
PSI_BDMS_HH_Screenshots_20131206.pdf Other-Instrument Screen Shots
Allogeneic UDHQ.pdf Other-Blood Donation Record Output Q
Autologous UDHQ.pdf Other-Blood Donation Record Output Q
Therapeutic UDHQ.pdf Other-Blood Donation Record Output Q
Compatibility Testing Output Record.pdf Other-Compatibility Testing Record O
Donor_Disclosure Statement.pdf Other-Donor On-Line Agency Disclosur

Information Collection (IC) Details

IC Title:	Enterprise Management Blood System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 200 Series 21 CFR 600 Series 21 CFR 800 Series

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Instrument Screen Shots	PSI_BDMS_HH_Screenshots_20131206.pdf	Yes	Yes	Fillable Fileable
Other-Blood Donation Record Output Qs 1-49	Allogeneic UDHQ.pdf	Yes	Yes	Fillable Fileable
Other-Blood Donation Record Output Qs 101-114	Autologous UDHQ.pdf	Yes	Yes	Fillable Fileable
Other-Blood Donation Record Output Qs 201-206	Therapeutic UDHQ.pdf	Yes	Yes	Fillable Fileable
Other-Compatibility Testing Record Output	Compatibility Testing Output Record.pdf	Yes	Yes	Fillable Fileable
Other-Donor On-Line Agency Disclosure Notice	Donor_Disclosure Statement.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,600	4,600
Annual IC Time Burden (Hours)	767	767
Annual IC Cost Burden (Dollars)	12,806	12,806

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.