Information Collection

OPTN- Liver Candidate Registration

IC 181739 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⚠️ Notice: This information collection may be referencing outdated material.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
Liver Transplant Candidate Registration Instructions.pdf	Instruction
15 Liver Adullt Transplant candidate Registration Worksheet Liver Adult Transplant Candidate Regisrtation Worksheet.pdf	Form
15b Liver Pediatric Transplant candidate Registration Worksh Liver Pediatric Transplant Candidate Registration Worksheet.pdf	Form

IC Title:

OPTN- Liver Candidate 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			Liver Transplant Candidate Registration Instructions.pdf	Yes	No	Printable Only
Form	15	Liver Adullt Transplant candidate Registration Worksheet	Liver Adult Transplant Candidate Regisrtation Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	15b	Liver Pediatric Transplant candidate Registration Worksheet	Liver Pediatric Transplant Candidate Registration Worksheet.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 132

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	12,936	-1,125	14,061
Annual IC Time Burden (Hours)	6,468	-563	7,031
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.