Information Collection

OPTN- Kidney Candidate Registration

IC 181736 under ICR 201010-0915-001 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 12b OPTN- Kidney Candidate Registration	Form
12b Kidney Candidate Pediatric Registration TCR Kidney Pediatric Wksheet.pdf	Form
12 Kidney Candidate Registration TCR Kidney Adult Wksheet.pdf	Form
Transplant Candidate Registration - Kidney.doc Transplant Candidate Registration - Kidney	IC Document

IC Title:

OPTN- Kidney Candidate Registration

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

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	12b	Kidney Candidate Pediatric Registration	TCR Kidney Pediatric Wksheet.pdf		Yes	Yes	Fillable Fileable
Form	12	Kidney Candidate Registration	TCR Kidney Adult 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: 241

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,103	10,853	33,250
Annual IC Time Burden (Hours)	22,052	12,742	9,310
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Transplant Candidate Registration - Kidney	Transplant Candidate Registration - Kidney.doc	09/14/2010

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