OPTN- Liver 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⚠️ Notice: This information collection may be referencing outdated material.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 17b OPTN- Liver Follow-up Form
17b Liver Pediatric Follow-up TRF Liver Pediatric Wksheet.pdf Form
17 Liver Follow-up TRF Liver Adult Wksheet.pdf Form
17d Post 5-Year Liver Pediatric Follow-up TRF Post 5-Year All Organs Pediatric Wksheet.pdf Form
17c Post 5-Year Liver Follow-up TRF Post 5-Year All Organs Adult Wksheet.pdf Form
Transplant Recipient Follow-up - Liver.doc Transplant Recipient Follow-up - Liver IC Document

Information Collection (IC) Details

IC Title:	OPTN- Liver 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	17b	Liver Pediatric Follow-up	TRF Liver Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	17	Liver Follow-up	TRF Liver Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	17d	Post 5-Year Liver Pediatric Follow-up	TRF Post 5-Year All Organs Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	17c	Post 5-Year Liver Follow-up	TRF Post 5-Year All Organs 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: 129	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	66,951	19,076	47,875
Annual IC Time Burden (Hours)	33,476	17,505	15,971
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transplant Recipient Follow-up - Liver	Transplant Recipient Follow-up - Liver.doc	09/14/2010

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