Information Collection Request

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

ICR 201010-0915-001 · OMB 0915-0157 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Deceased Donor Registration Form Modified Available
Form 1b Imminent-Eligible Death Doc Form Modified Available
Form Death Notification Death Notification Referral-Imminent Form and Instruction New Available
Form Death Notification Death Notification Referral _Eligible Form and Instruction New Available
Form Death Referral Dat Death Referral Data Form New Available
Form 27b Post Transplant Pediatric Malignancy Form Modified Available
Form 27 Post Transplant Malignancy Form Modified Available
Form 26d Post 5-Year Intestine Pediatric Follow-up Form Modified Available
Form 26c Post 5-Year Intestine Follow-up Form Modified Available
Form 26 Intestine Follow-up Form Modified Available
Form 26b Intestine Pediatric Follow-up Form Modified Available
Form 25 Intestine Registration Form Modified Available
Form 25b Intestine Pediatric Registration Form Modified Available
Form 24 Intestine Candidate Registration Form Modified Available
Form 24b Intestine Candidate Pediatric Registration Form Modified Available
Form 23d Post 5-Year Pancreas Pediatric Follow-up Form Modified Available
Form 23c Post 5-Year Pancreas Follow-up Form Modified Available
Form 23b Pancreas Pediatric Follow-up Form Modified Available
Form 23 Pancreas Follow-up Form Modified Available
Form 22 Pancreas Registration Form Modified Available
Form 22b Pancreas Pediatric Registration Form Modified Available
Form 21 Pancreas Candidate Registration Form Modified Available
Form 21b Pancreas Candidate Pediatric Registration Form Modified Available
Form 20d Post 5-Year Kidney/Pancreas Pediatric Follow-up Form Modified Available
Form 20c Post 5-Year Kidney/Pancreas Follow-up Form Modified Available
Form 20 Kidney/Pancreas Follow-up Form Modified Available
Form 20b Kidney/Pancreas Pediatric Follow-up Form Modified Available
Form 19b Kidney/Pancreas Pediatric Registration Form Modified Available
Form 19 Kidney/Pancreas Registration Form Modified Available
Form 18 Kidney /Pancreas Candidate Registration Form Modified Available
Form 18b Kidney/Pancreas Pediatric Candidate Registration Form Modified Available
Form 17c Post 5-Year Liver Follow-up Form Modified Available
Form 17d Post 5-Year Liver Pediatric Follow-up Form Modified Available
Form 17 Liver Follow-up Form Modified Available
Form 17b Liver Pediatric Follow-up Form Modified Available
Form 16b Liver Pediatric Registration Form Modified Available
Form 16 Liver Registration Form Modified Available
Form 15 Liver Candidate Registration Form Modified Available
Form 15b Liver Candidate Pediatric Registration Form Modified Available
Form 14d Post 5-Year Kidney Pediatric Follow-up Form Modified Available
Form 14c Post 5-Year Kidney Follow-up Form Modified Available
Form 14 Kidney Follow-up Form Modified Available
Form 14b Kidney Follow-up Pediatric Form Modified Repair queued
Form 13b KidneyPediatric Registration Form Modified Available
Form 13 Kidney Registration Form Modified Available
Form 12 Kidney Candidate Registration Form Modified Available
Form 12b Kidney Candidate Pediatric Registration Form Modified Available
Form 11f Post 5-Year Kidney Pediatric Follow-up Form Modified Available
Form 11e Post 5-Year Thoracic Follow-up Form Modified Available
Form 11d Thoracic Follow-up Annual Pediatric Form Modified Available
Form 11c Thoracic Follow-up Annual Form Modified Available
Form 11 Thoracic Follow-up Form Modified Available
Form 11b Thoracic Pediatric Follow-up Form Modified Available
Form 10 Thoracic Registration Form Modified Available
Form 10b Thoracic Pediatric Registration Form Modified Available
Form 9 Heart./Lung Candidate Registration Form Modified Repair queued
Form 9b Heart/Lung Pediatric Registration Form Modified Repair queued
Form 8b Lung Candidate Pediatric Registration Form Modified Available
Form 8 Lung Candidate Registration Form Modified Available
Form 7b Heart Candidate Pediatric Registration Form Modified Available
Form 7 Heart Candidate Registration Form Modified Available
Form 6 Recipient Histocompatibility Form Modified Available
Form 5 Donor Histocompatibility Form Modified Available
Form 4 Living Donor Follow-up Form Modified Available
Form 3 Living Donor Registration Form Modified Available
Form 2 Death Referral Data Form Removed Available
Death Referral, Imminent, and Eligible Instructions.pdf Supplementary Document Uploaded 2010-09-14 Available
Death Referral, Imminent, and Eligible Instructions.pdf Supplementary Document Uploaded 2010-09-14 Available
Post-Transplant Malignancy.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Intestine - Post 5-Year.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Intestine.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Registration - Intestine.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Intestine.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Pancreas - Post 5-Year.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Pancreas.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Registration - Pancreas.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Pancreas.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Kidney - Post 5-Year.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Kidney-Pancreas.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Kidney-Pancreas.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Kidney-Pancreas.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Liver.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Registration - Liver.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Liver.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Kidney - Post 5-Year.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Kidney.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Registration - Kidney.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Kidney.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Thoracic - Post 6-Month.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Thoracic - Post 5-Year.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Follow-up - Thoracic.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Recipient Registration - Thoracic.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Heart-Lung.doc Supplementary Document Uploaded 2010-09-14 Available
Transplant Candidate Registration - Lung.doc Supplementary Document Uploaded 2010-09-14 Available
TCR Heart Help.pdf Supplementary Document Uploaded 2007-07-17 Available
Recipient Histocompatibility Help.pdf Supplementary Document Uploaded 2007-07-17 Available
Donor Histocompatility Help.pdf Supplementary Document Uploaded 2007-07-17 Available
Living Donor Follow-up.doc Supplementary Document Uploaded 2010-09-14 Available
Living Donor Fol Help.pdf Supplementary Document Uploaded 2007-07-17 Available
Living Donor Reg Help.pdf Supplementary Document Uploaded 2007-07-17 Available
Death Referral Data Help.pdf Supplementary Document Uploaded 2007-07-17 Available
Deceased Donor Registration.doc Supplementary Document Uploaded 2010-09-13 Available
Supporting Statement OPTN UNET Forms_0157_2010.docx Supporting Statement A Uploaded 2010-09-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6389 OPTN- Deceased Donor Registration Worksheet Form ModifiedDeceased Donor Registration
6389 OPTN- Deceased Donor Registration Worksheet Form ModifiedImminent-Eligible Death Doc
194824 Death Notification Referral-Imminent Form and Instruction NewDeath Notification Referral-Imminent
194823 Death Notification Referal - Eligible Form and Instruction NewDeath Notification Referral _Eligible
194822 Death Referral Data Form NewDeath Referral Data
181751 OPTN- Post Transplant Malignancy Form ModifiedPost Transplant Pediatric Malignancy
181751 OPTN- Post Transplant Malignancy Form ModifiedPost Transplant Malignancy
181750 OPTN- Intestine Follow-up Form ModifiedPost 5-Year Intestine Pediatric Follow-up
181750 OPTN- Intestine Follow-up Form ModifiedPost 5-Year Intestine Follow-up
181750 OPTN- Intestine Follow-up Form ModifiedIntestine Follow-up
181750 OPTN- Intestine Follow-up Form ModifiedIntestine Pediatric Follow-up
181749 OPTN- Intestine Registration Form ModifiedIntestine Registration
181749 OPTN- Intestine Registration Form ModifiedIntestine Pediatric Registration
181748 OPTN- Intestine Candidate Registration Form ModifiedIntestine Candidate Registration
181748 OPTN- Intestine Candidate Registration Form ModifiedIntestine Candidate Pediatric Registration
181747 OPTN- Pancreas Follow-up Form ModifiedPost 5-Year Pancreas Pediatric Follow-up
181747 OPTN- Pancreas Follow-up Form ModifiedPost 5-Year Pancreas Follow-up
181747 OPTN- Pancreas Follow-up Form ModifiedPancreas Pediatric Follow-up
181747 OPTN- Pancreas Follow-up Form ModifiedPancreas Follow-up
181746 OPTN- Pancreas Registration Form ModifiedPancreas Registration
181746 OPTN- Pancreas Registration Form ModifiedPancreas Pediatric Registration
181745 OPTN- Pancreas Candidate Registration Form ModifiedPancreas Candidate Registration
181745 OPTN- Pancreas Candidate Registration Form ModifiedPancreas Candidate Pediatric Registration
181744 OPTN- Kidney/Pancreas Follow-up Form ModifiedPost 5-Year Kidney/Pancreas Pediatric Follow-up
181744 OPTN- Kidney/Pancreas Follow-up Form ModifiedPost 5-Year Kidney/Pancreas Follow-up
181744 OPTN- Kidney/Pancreas Follow-up Form ModifiedKidney/Pancreas Follow-up
181744 OPTN- Kidney/Pancreas Follow-up Form ModifiedKidney/Pancreas Pediatric Follow-up
181743 OPTN- Kidney/Pancreas Registration Form ModifiedKidney/Pancreas Pediatric Registration
181743 OPTN- Kidney/Pancreas Registration Form ModifiedKidney/Pancreas Registration
181742 OPTN- Kidney/Pancreas Candidate Registration Form ModifiedKidney /Pancreas Candidate Registration
181742 OPTN- Kidney/Pancreas Candidate Registration Form ModifiedKidney/Pancreas Pediatric Candidate Registration
181741 OPTN- Liver Follow-up Form ModifiedPost 5-Year Liver Follow-up
181741 OPTN- Liver Follow-up Form ModifiedPost 5-Year Liver Pediatric Follow-up
181741 OPTN- Liver Follow-up Form ModifiedLiver Follow-up
181741 OPTN- Liver Follow-up Form ModifiedLiver Pediatric Follow-up
181740 OPTN- Liver Registration Form ModifiedLiver Pediatric Registration
181740 OPTN- Liver Registration Form ModifiedLiver Registration
181739 OPTN- Liver Candidate Registration Form ModifiedLiver Candidate Registration
181739 OPTN- Liver Candidate Registration Form ModifiedLiver Candidate Pediatric Registration
181738 OPTN- Kidney Follow-up Form ModifiedPost 5-Year Kidney Pediatric Follow-up
181738 OPTN- Kidney Follow-up Form ModifiedPost 5-Year Kidney Follow-up
181738 OPTN- Kidney Follow-up Form ModifiedKidney Follow-up
181738 OPTN- Kidney Follow-up Form ModifiedKidney Follow-up Pediatric
181737 OPTN- Kidney Registration Form ModifiedKidneyPediatric Registration
181737 OPTN- Kidney Registration Form ModifiedKidney Registration
181736 OPTN- Kidney Candidate Registration Form ModifiedKidney Candidate Registration
181736 OPTN- Kidney Candidate Registration Form ModifiedKidney Candidate Pediatric Registration
181735 OPTN- Thoracic Follow-up Form ModifiedPost 5-Year Kidney Pediatric Follow-up
181735 OPTN- Thoracic Follow-up Form ModifiedPost 5-Year Thoracic Follow-up
181735 OPTN- Thoracic Follow-up Form ModifiedThoracic Follow-up Annual Pediatric
181735 OPTN- Thoracic Follow-up Form ModifiedThoracic Follow-up Annual
181735 OPTN- Thoracic Follow-up Form ModifiedThoracic Follow-up
181735 OPTN- Thoracic Follow-up Form ModifiedThoracic Pediatric Follow-up
181734 OPTN- Thoracic Registration Form ModifiedThoracic Registration
181734 OPTN- Thoracic Registration Form ModifiedThoracic Pediatric Registration
181733 OPTN- Heart/Lung Candidate Registration Form ModifiedHeart./Lung Candidate Registration
181733 OPTN- Heart/Lung Candidate Registration Form ModifiedHeart/Lung Pediatric Registration
181732 OPTN- Lung Candidate Registration Form ModifiedLung Candidate Pediatric Registration
181732 OPTN- Lung Candidate Registration Form ModifiedLung Candidate Registration
181731 OPTN- Heart Candidate Registration Form ModifiedHeart Candidate Pediatric Registration
181731 OPTN- Heart Candidate Registration Form ModifiedHeart Candidate Registration
181730 OPTN- Recipient Histocompatibility Form ModifiedRecipient Histocompatibility
181729 OPTN- Donor Histocompatibility Form ModifiedDonor Histocompatibility
181728 OPTN- Living Donor Follow-up Form ModifiedLiving Donor Follow-up
181727 OPTN- Living Donor Registration Form ModifiedLiving Donor Registration
181726 OPTN- Death Referral Form RemovedDeath Referral Data

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2011 36 Months From Approved 12/31/2010
522,815 0 388,628
278,769 0 131,473
0 0 0





Reginfo record details
29
table that charts list of burden
IC Title Form No. Form Name
Death Notification Referal - Eligible Death Notification Referral _Eligible
Death Notification Referral-Imminent Death Notification Referral-Imminent
Death Referral Data Death Referral Data
OPTN- Death Referral 2
OPTN- Deceased Donor Registration Worksheet 1, 1b ,  
OPTN- Donor Histocompatibility 5
OPTN- Heart Candidate Registration 7, 7b ,  
OPTN- Heart/Lung Candidate Registration 9b, 9 ,  
OPTN- Intestine Candidate Registration 24b, 24 ,  
OPTN- Intestine Follow-up 26b, 26, 26c, 26d ,   ,   ,  
OPTN- Intestine Registration 25b, 25 ,  
OPTN- Kidney Candidate Registration 12b, 12 ,  
OPTN- Kidney Follow-up 14b, 14, 14d, 14c ,   ,   ,  
OPTN- Kidney Registration 13b, 13 ,  
OPTN- Kidney/Pancreas Candidate Registration 18b, 18 ,  
OPTN- Kidney/Pancreas Registration 19, 19b ,  
OPTN- Liver Candidate Registration 15b, 15 ,  
OPTN- Liver Follow-up 17b, 17, 17c, 17d ,   ,   ,  
OPTN- Liver Registration 16, 16b ,  
OPTN- Living Donor Registration 3
OPTN- Lung Candidate Registration 8, 8b ,  
OPTN- Pancreas Candidate Registration 21b, 21 ,  
OPTN- Pancreas Follow-up 23, 23b, 23c, 23d ,   ,   ,  
OPTN- Pancreas Registration 22b, 22 ,  
OPTN- Post Transplant Malignancy 27, 27b ,  
OPTN- Recipient Histocompatibility 6
OPTN- Thoracic Follow-up 11b, 11, 11c, 11d, 11e, 11f ,   ,   ,   ,   ,  
OPTN- Thoracic Registration 10b, 10 ,  
OPTN- Kidney/Pancreas Follow-up 20b, 20, 20c, 20d ,   ,   ,  
OPTN- Living Donor Follow-up 4

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 522,815 388,628 0 -696 134,883 0
Annual Time Burden (Hours) 278,769 131,473 0 -6,960 154,256 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No