OPTN- Liver Follow-up

Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients Data System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Document Name Document Type
Form 17b OPTN- Liver Follow-up Form
17b Liver Pediatric Follow-up TRF Liver Pediatric Wksheet.pdf Form
17 Liver Follow-up TRF Liver Adult Wksheet.pdf Form
17d Post 5-Year Liver Pediatric Follow-up TRF Post 5-Year All Organs Pediatric Wksheet.pdf Form
17c Post 5-Year Liver Follow-up TRF Post 5-Year All Organs Adult Wksheet.pdf Form
TRF All Organs Doc.pdf Liver Follow-up Changes IC Document
TRF Liver Help.pdf Liver Follow-up Instructions IC Document
TRF Post 5-Year All Organs Doc.pdf Post 5-Year Liver Follow-up Changes IC Document
TRF Post 5-Year Liver Help.pdf Post 5-Year Liver Follow-up Instructions IC Document

Information Collection (IC) Details

IC Title:	OPTN- Liver Follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	17b	Liver Pediatric Follow-up	TRF Liver Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	17	Liver Follow-up	TRF Liver Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	17d	Post 5-Year Liver Pediatric Follow-up	TRF Post 5-Year All Organs Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	17c	Post 5-Year Liver Follow-up	TRF Post 5-Year All Organs Adult Wksheet.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	47,875	47,875
Annual IC Time Burden (Hours)	15,971	15,971
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Liver Follow-up Changes	TRF All Organs Doc.pdf	07/19/2007
Liver Follow-up Instructions	TRF Liver Help.pdf	07/19/2007
Post 5-Year Liver Follow-up Changes	TRF Post 5-Year All Organs Doc.pdf	07/23/2007
Post 5-Year Liver Follow-up Instructions	TRF Post 5-Year Liver Help.pdf	07/23/2007

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