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Organ Procurement and Transplantation Network Application
Organ Procurement and Transplantation Network
OMB: 0915-0184
IC ID: 6410
OMB.report
HHS/HSA
OMB 0915-0184
ICR 201102-0915-005
IC 6410
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:
2025-03-28 - No material or nonsubstantive change to a currently approved collection
2024-10-08 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 11
Organ Procurement and Transplantation Network Application
Form
B1_Cover_Instuctions_Add on program_2010_Nov.doc
www.optn.org
Instruction
0 0
A10_LDK_TX_program_appl_initial only.pdf
www.optn.org
Form
0 0
B2_New_LDL_only_Cover_Instructions_Add on program.pdf
www.optn.org
Form
1 A1_Full_App_Cover_Instructions
A1_Full Appl_Cover_instructions_2010_Nov.doc
www.optn.org
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
www.optn.org
Form
3 A3_KI_LDK_Combined_app
A3_KI_LDK_combined appl_2010_Nov.doc
www.optn.org
Form
5 A5_PA_app
A5_PA_appl_2010_Nov.doc
Form
6 A6_HR_App
A6_HR_appl_2010_Nov 22.doc
www.optn.org
Form
7 A7_LU_App
A7_LU_appl_2010_Nov 18.doc
www.optn.org
Form
8 C_OPO_App
C_OPO_application_independent_2010_Nov.doc
www.optn.og
Form
9 A8_HL_App
A8_HL_appl_2010_Nov.doc
www.optn.org
Form
10 A9_PI_App
A9_PI_appl_2010_Nov.doc
www.optn.org
Form
11 A10_OPO_Inhouse
A10_OPO_inhouse_2010_Nov_Part 5.doc
www.optn.org
Form
13 A12_Lab_section_part_6
A_11_Hospital based Lab_Part 6 Appl_2010_Nov.doc
www.optn.org
Form
14 E_Lab_Independent_app
E_Lab_Independent_Application_2010_Nov.doc
www.optn.org
Form
15 B2_NewLDL_only_Cover_instructions
D_LAB_inhouse_appl_cover_and_Instructions_2010_Nov.doc
www.optn.org
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
11
A10_OPO_Inhouse
A10_OPO_inhouse_2010_Nov_Part 5.doc
www.optn.org
Yes
No
Printable Only
Form
13
A12_Lab_section_part_6
A_11_Hospital based Lab_Part 6 Appl_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Instruction
B1_Cover_Instuctions_Add on program_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Form
14
E_Lab_Independent_app
E_Lab_Independent_Application_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Form
15
B2_NewLDL_only_Cover_instructions
D_LAB_inhouse_appl_cover_and_Instructions_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Form
0
0
A10_LDK_TX_program_appl_initial only.pdf
www.optn.org
Yes
No
Printable Only
Form
0
0
B2_New_LDL_only_Cover_Instructions_Add on program.pdf
www.optn.org
Yes
No
Printable Only
Form and Instruction
1
A1_Full_App_Cover_Instructions
A1_Full Appl_Cover_instructions_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Form
4
A4_LI_LDL_combined_app
A4_LI_LDL_combined_appl_2010_Nov.doc
Yes
No
Printable Only
Form
2
A2_part_1_2_General_facility
A2_Part 1_2_General_Facility.doc
www.optn.org
Yes
No
Printable Only
Form
3
A3_KI_LDK_Combined_app
A3_KI_LDK_combined appl_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Form
5
A5_PA_app
A5_PA_appl_2010_Nov.doc
Yes
No
Printable Only
Form
6
A6_HR_App
A6_HR_appl_2010_Nov 22.doc
www.optn.org
Yes
No
Printable Only
Form
7
A7_LU_App
A7_LU_appl_2010_Nov 18.doc
www.optn.org
Yes
No
Printable Only
Form
8
C_OPO_App
C_OPO_application_independent_2010_Nov.doc
www.optn.og
Yes
No
Printable Only
Form
9
A8_HL_App
A8_HL_appl_2010_Nov.doc
www.optn.org
Yes
No
Printable Only
Form
10
A9_PI_App
A9_PI_appl_2010_Nov.doc
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
120
0
0
80
0
40
Annual IC Time Burden (Hours)
1,800
0
0
0
0
1,800
Annual IC Cost Burden (Dollars)
0
0
0
0
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.