OPTN- Thoracic Follow-up

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⚠️ Notice: This information collection may be referencing outdated material.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 11b OPTN- Thoracic Follow-up Form
11b Thoracic Pediatric Follow-up TRF Thoracic 6 Month Pediatric Wksheet.pdf Form
11 Thoracic Follow-up TRF Thoracic 6 Month Adult Wksheet.pdf Form
11c Thoracic Follow-up Annual TRF Thoracic Adult Wksheet.pdf Form
11d Thoracic Follow-up Annual Pediatric TRF Thoracic Pediatric Wksheet.pdf Form
11e Post 5-Year Thoracic Follow-up TRF Post 5-Year All Organs Adult Wksheet.pdf Form
11f Post 5-Year Kidney Pediatric Follow-up TRF Post 5-Year All Organs Pediatric Wksheet.pdf Form
Transplant Recipient Follow-up - Thoracic.doc Transplant Recipient Follow-up - Thoracic IC Document
Transplant Recipient Follow-up - Thoracic - Post 5-Year.doc Transplant Recipient Follow-up - Thoracic - Post 5-Year IC Document
Transplant Recipient Follow-up - Thoracic - Post 6-Month.doc Transplant Recipient Follow-up - Thoracic - Post 6-Month IC Document

Information Collection (IC) Details

IC Title:	OPTN- Thoracic Follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	11b	Thoracic Pediatric Follow-up	TRF Thoracic 6 Month Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	11	Thoracic Follow-up	TRF Thoracic 6 Month Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	11c	Thoracic Follow-up Annual	TRF Thoracic Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	11d	Thoracic Follow-up Annual Pediatric	TRF Thoracic Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	11e	Post 5-Year Thoracic Follow-up	TRF Post 5-Year All Organs Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	11f	Post 5-Year Kidney Pediatric Follow-up	TRF Post 5-Year All Organs Pediatric 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: 127	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40,640	9,725	30,915
Annual IC Time Burden (Hours)	26,416	13,648	12,768
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transplant Recipient Follow-up - Thoracic	Transplant Recipient Follow-up - Thoracic.doc	09/14/2010
Transplant Recipient Follow-up - Thoracic - Post 5-Year	Transplant Recipient Follow-up - Thoracic - Post 5-Year.doc	09/14/2010
Transplant Recipient Follow-up - Thoracic - Post 6-Month	Transplant Recipient Follow-up - Thoracic - Post 6-Month.doc	09/14/2010

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