BLOOD SAMPLE IDENTIFICATION CARD

ICR 198012-0910-002

OMB: 0910-0058

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
109519 Migrated
ICR Details
0910-0058 198012-0910-002
Historical Active 197708-0910-002
HHS/FDA
BLOOD SAMPLE IDENTIFICATION CARD
Extension without change of a currently approved collection   No
Regular
Approved without change 02/23/1981
Retrieve Notice of Action (NOA) 12/11/1980
FURTHER APPROVAL OF THIS FORM IS CONTINGENT UPON SATISFACTORY RESPONSE TO THE FOLLOWING QUESTIONS: (1) HOW DOES THE QUESTION ON RELIGION ACHIEVE THE PURPOSE OF THE FORM? WHAT OTHER PURPOSES, IF ANY, ARE ACHIEVED? (2) WHAT WAYS, IF ANY, OTHER THAN ASKING RELIGION, CAN THE PURPOSE OF THIS FORM BE ACHIEVED? (3) PHS' JANUARY 28, 1981 MEMORANDUM TO OMB STATES THAT ASIANS WHO CALL THEMSELVES HINDU OR MUSLIM "HAVE DISTINCTLY BIOLOGICAL CHARACTERISTICS OF THE BLOOD." WHAT COMMONLY USED MEDICAL TEXTBOOKS OR ARTICLES IN RELIABLE MEDICAL JOURNALS SUBSTANTIATE THIS STATEMENT? (4) IF RELIGIOUS SPECIFICITY IS IMPORTANT, WHY NOT ASK MUSLINS IF THEY ARE OF THE SUNNI OR SHI'ITE SECT? THESE TWO SECTS ALSO HAVE, IN THE WORDS OF THE PHS MEMORANDUM, "POPULATION PURITY." (5) HOW RELEVANT IS THE INFORMATION ABOUT A DONER'S RELIGION IN LIGHT OF THE FACT THAT THE FORM HAS AN "OTHER" CATEGORY?
  Inventory as of this Action Requested Previously Approved
06/30/1981 06/30/1981 12/31/1980
200 0 200
33 0 33
0 0 0

THE FORM PROVIDES INFORMATION FROM BLOOD DONORS WHICH IS ENTERED INTO A COMPUTER WITH TISSUE TYPING AND OTHER INFORMATION CONCERNING GENETIC CHARACTERISTICS. THE RESULTS WILL DETERMINE THE TYPE OF TESTS FOR WHICH THE BLOOD CELLS WILL BE USED.

None
None


No

1
IC Title Form No. Form Name
BLOOD SAMPLE IDENTIFICATION CARD FD 3059

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 200 0 0 0 0
Annual Time Burden (Hours) 33 33 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/11/1980


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