OPTN- Deceased Donor Registration Worksheet

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⚠️ Notice: This information collection may be referencing outdated material.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 1b OPTN- Deceased Donor Registration Worksheet Form
1b Imminent-Eligible Death Doc Imminent-Eligible Death Wksheet.pdf Form
1 Deceased Donor Registration FINALDeceased Donor Registration Wksheet.pdf Form
Deceased Donor Registration.doc Deceased Donor Registration IC Document

Information Collection (IC) Details

IC Title:	OPTN- Deceased Donor Registration Worksheet	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1b	Imminent-Eligible Death Doc	Imminent-Eligible Death Wksheet.pdf		Yes	Yes	Fillable Fileable
Form	1	Deceased Donor Registration	FINALDeceased Donor Registration 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: 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	Previously Approved
Annual Number of Responses for this IC	12,528	58	12,470
Annual IC Time Burden (Hours)	9,396	4,159	5,237
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Deceased Donor Registration	Deceased Donor Registration.doc	09/13/2010

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