Information Collection

OPTN Appeal for Membership

IC 183030 under ICR 200712-0915-001 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

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Information Collection (IC) Details

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IC Title:	OPTN Appeal for Membership	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 121 42 CFR 121.3(b)(4)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	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: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	46	46

Documents for IC

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