Rapid Response Survey for Hepatitis E Virus-Exposure Blood Donors

Generic FDA Rapid Response Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Document Name Document Type
Questionnaire 0500 Hep E-Virus 9-30-2015.docx Other-Survey
Consent Form - Hep E Virus Exposure.doc Consent Form IC Document
OMB Justification Memo for Hepatitis E Virus-Exposure Rapid Survey of Blood Donors 0500 9-30-2015 .docx OMB Justification Memo for Generic Clearance of Rapid Response Survey IC Document

Information Collection (IC) Details

IC Title:	Rapid Response Survey for Hepatitis E Virus-Exposure Blood Donors	Agency IC Tracking Number:	CBER

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-Survey			Questionnaire 0500 Hep E-Virus 9-30-2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	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	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form	Consent Form - Hep E Virus Exposure.doc	09/30/2015
OMB Justification Memo for Generic Clearance of Rapid Response Survey	OMB Justification Memo for Hepatitis E Virus-Exposure Rapid Survey of Blood Donors 0500 9-30-2015 .docx	09/30/2015

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