Information Collection

OPTN- Thoracic Registration

IC 181734 under ICR 201202-0915-001 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 Thoracic Heart Adult Transplant Recipient Registration Worksheet OPTN- Thoracic Registration	Form
Form 10b Thoracic Heart Pediatric Transplant Recipient Registration Worksheet OPTN- Thoracic Registration	Form
Form 10c Thoracic Heart-Lung Adult Transplant Recipient Regisration Worksheet OPTN- Thoracic Registration	Form
Form 10d Thoracic Heart-Lung Pediatric Transplant Recipient Registration Worksheet OPTN- Thoracic Registration	Form
Form 10e Thoracic Lung Adult Transplant Recipient Registration Worksheet OPTN- Thoracic Registration	Form
Form 10f Thoracic Lung Pediatric Transplant Recipient Registration Worksheet OPTN- Thoracic Registration	Form
Thoracic Transplant Recipient Registration Instructions.pdf	Instruction
10 Thoracic Heart Adult Transplant Recipient Registration W Thoracic Heart Adult Transplant Recipient Registration Worksheet.pdf	Form
10b Thoracic Heart Pediatric Transplant Recipient Registrati Thoracic Heart Pediatric Transplant Recipient Registration Worksheet.pdf	Form
10c Thoracic Heart-Lung Adult Transplant Recipient Regisrati Thoracic Heart-Lung Adult Transplant Recipient Registration Worksheet.pdf	Form
10d Thoracic Heart-Lung Pediatric Transplant Recipient Regis Thoracic Heart-Lung Pediatric Transplant Recipient Registration Worksheet.pdf	Form
10e Thoracic Lung Adult Transplant Recipient Registration Wo Thoracic Lung Adult Transplant Recipient Registration Worksheet.pdf	Form
10f Thoracic Lung Pediatric Transplant Recipient Registratio Thoracic Lung Pediatric Transplant Recipient Registration Worksheet.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

OPTN- Thoracic Registration

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Thoracic Transplant Recipient Registration Instructions.pdf	Yes	No	Printable Only
Form	10	Thoracic Heart Adult Transplant Recipient Registration Worksheet	Thoracic Heart Adult Transplant Recipient Registration Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	10b	Thoracic Heart Pediatric Transplant Recipient Registration Worksheet	Thoracic Heart Pediatric Transplant Recipient Registration Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	10c	Thoracic Heart-Lung Adult Transplant Recipient Regisration Worksheet	Thoracic Heart-Lung Adult Transplant Recipient Registration Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	10d	Thoracic Heart-Lung Pediatric Transplant Recipient Registration Worksheet	Thoracic Heart-Lung Pediatric Transplant Recipient Registration Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	10e	Thoracic Lung Adult Transplant Recipient Registration Worksheet	Thoracic Lung Adult Transplant Recipient Registration Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	10f	Thoracic Lung Pediatric Transplant Recipient Registration Worksheet	Thoracic Lung Pediatric Transplant Recipient Registration Worksheet.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 131

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,454	-118	4,572
Annual IC Time Burden (Hours)	3,341	-88	3,429
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.