Facility Annual Return Form

Please click the following link to access the online form:

CLICK HERE to access Facility Annual Return form

The Facility Annual Return Form must be completed by the main facility. For more information, please refer to the instructions below.

Note: Information provided to ICCBBA will be used for billing and registration purposes, and to assist ICCBBA in its operations – this may include periodic surveys or any other type of announcement. If you wish to opt-out of surveys or announcements, please contact us. To view our full privacy policy, visit the following URL: https://www.iccbba.org/about-iccbba/policies.


Facility Annual Return Instructions

Determine which form(s) you need to complete.

    1. If you are registered as a corporation that requested multiple FINs under a single registration, complete this form and an Associated Facility Annual Return Form for EACH facility that has an assigned FIN.

      For example, Large University Medical Center (FIN is W0001) has three associated facilities under a single ICCBBA registration: Large University Medical Center - Bedford (W0002), Large University Medical Center - Centerville (W0003) and Large University Medical Center - Springfield (W0004). This organization should complete the Facility Annual Return Form for Large University Medical Center (W0001) and an Associated Facility Annual Return Form for each of the three other hospitals (Bedford, Centerville and Springfield).

    2. In the Activity Box, enter aggregate numbers for all facilities associated with this registration (if applicable).

      For example, using the facilities described above, Large University Medical Center collects 23,000 units of whole blood each year. Bedford collects 6,000; Centerville 4,000; and Springfield 2,000. For Whole Blood Units Collected, enter the total for the 4 hospitals (35,000).

    3. For Human Development Index (HDI), enter if your facility is in a Medium or Low HDI country. You can view a list of countries around the world and their corresponding HDI here.

For all additional Facility Identification Numbers (FINs) associated with this registration, complete an Associated Facility Annual Return Form.

 

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