Information Collection

OPTN Non-Institutional Application

IC 183029 under ICR 201403-0915-002 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form H OPTN Non-Institutional Application	Form and Instruction
H Application for Medical/Scientific Organization Membersh H_MedicalScientific.doc	Form and Instruction
I Application for Public Organization Membership I_PublicOrg.doc	Form and Instruction
J Application for Business Membership J_Business.doc	Form and Instruction
K Application for Individual Membership K_Individual.doc	Form and Instruction

IC Title:

OPTN Non-Institutional Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 121

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
Form and Instruction	H	Application for Medical/Scientific Organization Membership	H_MedicalScientific.doc	Yes	Yes	Fillable Printable
Form and Instruction	I	Application for Public Organization Membership	I_PublicOrg.doc	Yes	Yes	Fillable Printable
Form and Instruction	J	Application for Business Membership	J_Business.doc	Yes	Yes	Fillable Printable
Form and Instruction	K	Application for Individual Membership	K_Individual.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 31

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: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	31	0	11	20
Annual IC Time Burden (Hours)	56	-144	0	200
Annual IC Cost Burden (Dollars)	0	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.