OPTN Non-Institutional Application

Organ Procurement and Transplantation Network

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 2 OPTN Non-Institutional Application Form and Instruction
2 G_medical_scientific_app G_Medical_Scientific_Org_appl_2010_Nov.doc www.optn.org Form and Instruction
1 Business_Member_app I_Business_member_appl_2010_Nov.doc www.optn.org Form and Instruction
3 Public_organ_app H_Public_Org_appl_2010_Nov.doc Form and Instruction
4 Individual_member_app J_Individual_member_appl_2010_Nov.doc www.optn.org Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Non-Institutional Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 121

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	G_medical_scientific_app	G_Medical_Scientific_Org_appl_2010_Nov.doc	www.optn.org	Yes	No	Printable Only
Form and Instruction	1	Business_Member_app	I_Business_member_appl_2010_Nov.doc	www.optn.org	Yes	No	Printable Only
Form and Instruction	3	Public_organ_app	H_Public_Org_appl_2010_Nov.doc		Yes	No	Printable Only
Form and Instruction	4	Individual_member_app	J_Individual_member_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: 20	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.