Information Collection

Organ Procurement and Transplantation Network Application

IC 6410 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⚠️ Notice: This information collection may be referencing outdated material.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 0 0 Organ Procurement and Transplantation Network Application	Form
Form 0 0 Organ Procurement and Transplantation Network Application	Form
Form 1 A1_Full_App_Cover_Instructions Organ Procurement and Transplantation Network Application	Form and Instruction
Form 4 A4_LI_LDL_combined_app Organ Procurement and Transplantation Network Application	Form
Form 2 A2_part_1_2_General_facility Organ Procurement and Transplantation Network Application	Form
Form 3 A3_KI_LDK_Combined_app Organ Procurement and Transplantation Network Application	Form
Form 5 A5_PA_app Organ Procurement and Transplantation Network Application	Form
Form 6 A6_HR_App Organ Procurement and Transplantation Network Application	Form
Form 7 A7_LU_App Organ Procurement and Transplantation Network Application	Form
Form 8 C_OPO_App Organ Procurement and Transplantation Network Application	Form
Form 9 A8_HL_App Organ Procurement and Transplantation Network Application	Form
Form 10 A9_PI_App Organ Procurement and Transplantation Network Application	Form
Form 11 A10_OPO_Inhouse Organ Procurement and Transplantation Network Application	Form
Form 13 A12_Lab_section_part_6 Organ Procurement and Transplantation Network Application	Form
Form 14 E_Lab_Independent_app Organ Procurement and Transplantation Network Application	Form
Form 15 B2_NewLDL_only_Cover_instructions Organ Procurement and Transplantation Network Application	Form
B1_Cover_Instuctions_Add on program_2010_Nov.doc	Instruction
0 0 A10_LDK_TX_program_appl_initial only.pdf	Form
0 0 B2_New_LDL_only_Cover_Instructions_Add on program.pdf	Form
1 A1_Full_App_Cover_Instructions A1_Full Appl_Cover_instructions_2010_Nov.doc	Form and Instruction
4 A4_LI_LDL_combined_app A4_LI_LDL_combined_appl_2010_Nov.doc	Form
2 A2_part_1_2_General_facility A2_Part 1_2_General_Facility.doc	Form
3 A3_KI_LDK_Combined_app A3_KI_LDK_combined appl_2010_Nov.doc	Form
5 A5_PA_app A5_PA_appl_2010_Nov.doc	Form
6 A6_HR_App A6_HR_appl_2010_Nov 22.doc	Form
7 A7_LU_App A7_LU_appl_2010_Nov 18.doc	Form
8 C_OPO_App C_OPO_application_independent_2010_Nov.doc	Form
9 A8_HL_App A8_HL_appl_2010_Nov.doc	Form
10 A9_PI_App A9_PI_appl_2010_Nov.doc	Form
11 A10_OPO_Inhouse A10_OPO_inhouse_2010_Nov_Part 5.doc	Form
13 A12_Lab_section_part_6 A_11_Hospital based Lab_Part 6 Appl_2010_Nov.doc	Form
14 E_Lab_Independent_app E_Lab_Independent_Application_2010_Nov.doc	Form
15 B2_NewLDL_only_Cover_instructions D_LAB_inhouse_appl_cover_and_Instructions_2010_Nov.doc	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Organ Procurement and Transplantation Network 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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0	www.optn.org	Yes	No	Printable Only
Form	0	www.optn.org	Yes	No	Printable Only
Form and Instruction	1	www.optn.org	Yes	No	Printable Only
Form	4		Yes	No	Printable Only
Form	2	www.optn.org	Yes	No	Printable Only
Form	3	www.optn.org	Yes	No	Printable Only
Form	5		Yes	No	Printable Only
Form	6	www.optn.org	Yes	No	Printable Only
Form	7	www.optn.org	Yes	No	Printable Only
Form	8	www.optn.og	Yes	No	Printable Only
Form	9	www.optn.org	Yes	No	Printable Only
Form	10	www.optn.org	Yes	No	Printable Only
Form	11	www.optn.org	Yes	No	Printable Only
Form	13	www.optn.org	Yes	No	Printable Only
Instruction		www.optn.org	Yes	No	Printable Only
Form	14	www.optn.org	Yes	No	Printable Only
Form	15	www.optn.org	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	120	80	40
Annual IC Time Burden (Hours)	1,800	0	1,800
Annual IC Cost Burden (Dollars)	0	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.

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