Information Collection

OPTN- Liver Follow-up

IC 181741 under ICR 200708-0915-004 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 17b Liver Pediatric Follow-up OPTN- Liver Follow-up	Form
Form 17 Liver Follow-up OPTN- Liver Follow-up	Form
Form 17d Post 5-Year Liver Pediatric Follow-up OPTN- Liver Follow-up	Form
Form 17c Post 5-Year Liver Follow-up 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

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	17b	Yes	Yes	Fillable Fileable
Form	17	Yes	Yes	Fillable Fileable
Form	17d	Yes	Yes	Fillable Fileable
Form	17c	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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Liver Follow-up Changes		07/19/2007
Liver Follow-up Instructions		07/19/2007
Post 5-Year Liver Follow-up Changes		07/23/2007
Post 5-Year Liver Follow-up Instructions		07/23/2007

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

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