OPTN- Death Referral

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⚠️ Notice: This information collection may be referencing outdated material.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 2 OPTN- Death Referral Form
2 Death Referral Data Death Referral Data Wksheet.pdf Form
Death Referral Data Help.pdf Death Referral Instructions IC Document
Death Referral Data Doc.pdf Death Referral Changes IC Document

Information Collection (IC) Details

IC Title:	OPTN- Death Referral	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	Death Referral Data	Death Referral Data 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: 58	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 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-696	696
Annual IC Time Burden (Hours)	-6,960	6,960
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Death Referral Instructions	Death Referral Data Help.pdf	07/17/2007
Death Referral Changes	Death Referral Data Doc.pdf	07/17/2007

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