OPTN- Pancreas 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⚠️ Notice: This information collection may be referencing outdated material.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 23 OPTN- Pancreas Follow-up Form
23 Pancreas Follow-up TRF Pancreas Adult Wksheet.pdf Form
23b Pancreas Pediatric Follow-up TRF Pancreas Pediatric Wksheet.pdf Form
23c Post 5-Year Pancreas Follow-up TRF Post 5-Year All Organs Adult Wksheet.pdf Form
23d Post 5-Year Pancreas Pediatric Follow-up TRF Post 5-Year All Organs Pediatric Wksheet.pdf Form
Transplant Recipient Follow-up - Pancreas.doc Transplant Recipient Follow-up - Pancreas IC Document
Transplant Recipient Follow-up - Pancreas - Post 5-Year.doc Transplant Recipient Follow-up - Pancreas - Post 5-Year IC Document

Information Collection (IC) Details

IC Title:	OPTN- Pancreas 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	23	Pancreas Follow-up	TRF Pancreas Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	23b	Pancreas Pediatric Follow-up	TRF Pancreas Pediatric Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	23c	Post 5-Year Pancreas Follow-up	TRF Post 5-Year All Organs Adult Wksheet.pdf	Yes	Yes	Fillable Fileable
Form	23d	Post 5-Year Pancreas 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: 143	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	2,860	-498	3,358
Annual IC Time Burden (Hours)	1,859	471	1,388
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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

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