OPTN- Thoracic Follow-up

Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients Data System

OMB: 0915-0157

IC ID: 181735

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Thoracic 6 Month Transplant Recipient Follow Up Instructions.pdf Instruction
Thoracic Post 5 Year Transplant Recipient Follow Up Instructions.pdf Instruction
Thoracic Transplant Recipient Follow Up Instructions.pdf Instruction
1 Thoracic Heart Adult 6 month Follow-up Thoracic Heart Adult 6 Month Transplant Recipient Follow Up Worksheet.pdf Form
2 Thoracic Heart Adult Post 5 year Thoracic Heart Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
5 Thoracic Heart Pediatric Post 5 Follow Up Thoracic Heart Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
7 Thoracic Heart Lung Adult Six month Thoracic Heart-Lung Adult 6 Month Transplant Recipient Follow Up Worksheet.pdf Form
8 Thoracic Heart Lung Adult Post 5 Thoracic Heart-Lung Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
11 Thoracic Heart Lung Pediatric Post 5 Thoracic Heart-Lung Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
13 Thoracic Lung Adult 6 month Follow UP Thoracic Lung Adult 6 Month Transplant Recipient Follow Up Worksheet.pdf Form
14 Thoracic Lung Adult Post 5 Follow Up Thoracic Lung Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
17 Thoracic Lung Pediatric Post 5 Thoracic Lung Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
3 Thoracic Heart Adult Transplant Recipient Follow Up Thoracic_Heart_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
4 Thoracic Heart Pediatric 6 Month Transplant Recipient Fo Thoracic_Heart_Pediatric_6_Month_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
6 Thoracic Heart Pediatric Transplant Recipient Follow Up Thoracic_Heart_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
9 Thoracic Heart Lung Adult Transplant Recipient Follow Up Thoracic_Heart-Lung_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
10 Thoracic Heart Lung Pediatric 6 Month Transplant Recipie Thoracic_Heart-Lung_Pediatric_6_Month_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
12 Thoracic Heart Lung Pediatric Transplant Recipient Follo Thoracic_Heart-Lung_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
15 Thoracic Lung Adult Transplant Recipient Follow Up Thoracic_Lung_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
16 Thoracic Lung Pediatric 6 Month Transplant Recipient Fol Thoracic_Lung_Pediatric_6_Month_Transplant_Recipient_Follow_Up_Worksheet.pdf Form
18 Thoracic Lung Pediatric Transplant Recipient Follow Up Thoracic_Lung_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OPTN- Thoracic Follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Thoracic Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Form	15	Thoracic Lung Adult Transplant Recipient Follow Up	Thoracic_Lung_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	3	Thoracic Heart Adult Transplant Recipient Follow Up	Thoracic_Heart_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	16	Thoracic Lung Pediatric 6 Month Transplant Recipient Follow Up	Thoracic_Lung_Pediatric_6_Month_Transplant_Recipient_Follow_Up_Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	9	Thoracic Heart Lung Adult Transplant Recipient Follow Up	Thoracic_Heart-Lung_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	10	Thoracic Heart Lung Pediatric 6 Month Transplant Recipient Follow Up	Thoracic_Heart-Lung_Pediatric_6_Month_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	12	Thoracic Heart Lung Pediatric Transplant Recipient Follow Up	Thoracic_Heart-Lung_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	6	Thoracic Heart Pediatric Transplant Recipient Follow Up	Thoracic_Heart_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	No	Fillable Fileable
Form	18	Thoracic Lung Pediatric Transplant Recipient Follow Up	Thoracic_Lung_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	4	Thoracic Heart Pediatric 6 Month Transplant Recipient Follow Up	Thoracic_Heart_Pediatric_6_Month_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	1	Thoracic Heart Adult 6 month Follow-up	Thoracic Heart Adult 6 Month Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	2	Thoracic Heart Adult Post 5 year	Thoracic Heart Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	5	Thoracic Heart Pediatric Post 5 Follow Up	Thoracic Heart Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	7	Thoracic Heart Lung Adult Six month	Thoracic Heart-Lung Adult 6 Month Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	8	Thoracic Heart Lung Adult Post 5	Thoracic Heart-Lung Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	11	Thoracic Heart Lung Pediatric Post 5	Thoracic Heart-Lung Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	13	Thoracic Lung Adult 6 month Follow UP	Thoracic Lung Adult 6 Month Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	14	Thoracic Lung Adult Post 5 Follow Up	Thoracic Lung Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	17	Thoracic Lung Pediatric Post 5	Thoracic Lung Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Instruction			Thoracic 6 Month Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Instruction			Thoracic Post 5 Year Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only

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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	36,287	-4,353	40,640
Annual IC Time Burden (Hours)	23,587	-2,829	26,416
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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