Information Collection

OPTN Personnel Change Application

IC 183028 under ICR 201102-0915-005 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 F_Cover_Instructions_Personnel OPTN Personnel Change Application	Form and Instruction
1 F_Cover_Instructions_Personnel F_Cover_and_Instructions_Personnel Change Appl_2010_Nov.doc	Form and Instruction

IC Title:

OPTN Personnel Change Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 121

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	F_Cover_Instructions_Personnel	F_Cover_and_Instructions_Personnel Change Appl_2010_Nov.doc	www.optn.org	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 324

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	324	324
Annual IC Time Burden (Hours)	3,240	3,240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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