Information Collection

OPTN- Liver Follow-up

IC 181741 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.