Information Collection

Organ Procurement and Transplantation Network Application

IC 6410 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0 Organ Procurement and Transplantation Network Application	Form
B1_Cover_Instuctions_Add on program_20071109.pdf www.optn.org	Instruction
0 0 A1_Full Appl_Cover_instructions_20071109.pdf www.optn.org	Form and Instruction
0 0 A2_Part 1_2_General_Facility.pdf www.optn.org	Form
0 0 A3_KI_LDK_combined appl.pdf www.optn.org	Form
0 0 A4_LI_LDL_combined_appl.pdf www.optn.org	Form
0 0 A5_PA_appl.pdf www.optn.org	Form
0 0 A6_HR_appl.pdf www.optn.org	Form
0 0 A7_LU_appl.pdf www.optn.org	Form
0 0 C_OPO_application_independent_revised.pdf www.optn.org	Form
0 0 A8_HL_appl.pdf www.optn.org	Form
0 0 A9_PI_appl.pdf www.optn.org	Form
0 0 A10_LDK_TX_program_appl_initial only.pdf www.optn.org	Form
0 0 A11_Part 5_OPO_inhouse.pdf www.optn.org	Form
0 0 A12_Lab_Section_Part 6_Full Appl.pdf www.optn.org	Form
0 0 B2_New_LDL_only_Cover_Instructions_Add on program.pdf www.optn.org	Form
0 0 E_Lab_Independent_Application_revised.pdf www.optn.org	Form
0 0 D_LAB_inhouse_full_appl_cover & Instructions_revised.pdf www.optn.org	Form

IC Title:

Organ Procurement and Transplantation Network Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 121

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0	0	E_Lab_Independent_Application_revised.pdf	www.optn.org	Yes	No	Printable Only
Form and Instruction	0	0	A1_Full Appl_Cover_instructions_20071109.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A2_Part 1_2_General_Facility.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A3_KI_LDK_combined appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A4_LI_LDL_combined_appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A5_PA_appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A6_HR_appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A7_LU_appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	C_OPO_application_independent_revised.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A8_HL_appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A9_PI_appl.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A10_LDK_TX_program_appl_initial only.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A11_Part 5_OPO_inhouse.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	A12_Lab_Section_Part 6_Full Appl.pdf	www.optn.org	Yes	No	Printable Only
Instruction			B1_Cover_Instuctions_Add on program_20071109.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	B2_New_LDL_only_Cover_Instructions_Add on program.pdf	www.optn.org	Yes	No	Printable Only
Form	0	0	D_LAB_inhouse_full_appl_cover & Instructions_revised.pdf	www.optn.org	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	-36,417	36,457
Annual IC Time Burden (Hours)	1,800	-17,659	19,459
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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