Death Notification Referral-Imminent

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⚠️ Notice: This information collection may be referencing outdated material.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 Death Notification Death Notification Referral-Imminent Form and Instruction
Death Notification Death Notification Referral-Imminent Death Notification Referral - Imminent.pdf Form and Instruction
Death Referral, Imminent, and Eligible Instructions.pdf Death Referral, Imminent, and Eligible Instructions IC Document

Information Collection (IC) Details

IC Title:	Death Notification Referral-Imminent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Death Notification Referral-Imminent	Death Notification Referral-Imminent	Death Notification Referral - Imminent.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 58	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
Annual Number of Responses for this IC	9,744	9,744
Annual IC Time Burden (Hours)	4,872	4,872
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Death Referral, Imminent, and Eligible Instructions	Death Referral, Imminent, and Eligible Instructions.pdf	09/14/2010

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