OPTN- Liver Follow-up

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

⚠️ Notice: This information collection may be referencing outdated material.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
Form 17 OPTN- Liver Follow-up Form
Liver Post 5 Year Transplant Recipient Follow Up Instructions.pdf Instruction
Liver Transplant Recipient Follow Up Instructions.pdf Instruction
17 Liver Adult Post 5 year Transplant Recipient Follow Up W Liver Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
17c Liver Pediatric Post 5 Year Transplant Recipient Follow Liver Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf Form
17b Liver Adult Transplant Recipient Follow Up Worksheet Liver_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form
17d Liver Pediatric Transplant Recipient Follow Up Worksheet Liver_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf Form

Information Collection (IC) Details

IC Title:	OPTN- Liver 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
Form	17	Liver Adult Post 5 year Transplant Recipient Follow Up Worksheet	Liver Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Instruction			Liver Post 5 Year Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Instruction			Liver Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Form	17c	Liver Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet	Liver Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	17b	Liver Adult Transplant Recipient Follow Up Worksheet	Liver_Adult_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	Yes	Fillable Fileable
Form	17d	Liver Pediatric Transplant Recipient Follow Up Worksheet	Liver_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	60,588	-6,363	66,951
Annual IC Time Burden (Hours)	30,294	-3,182	33,476
Annual IC Cost Burden (Dollars)	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.