Information Collection

OPTN- Thoracic Follow-up

IC 181735 under ICR 201411-0915-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1 Thoracic Heart Adult 6 month Follow-up OPTN- Thoracic Follow-up	Form
Form 2 Thoracic Heart Adult Post 5 year OPTN- Thoracic Follow-up	Form
Form 5 Thoracic Heart Pediatric Post 5 Follow Up OPTN- Thoracic Follow-up	Form
Form 7 Thoracic Heart Lung Adult Six month OPTN- Thoracic Follow-up	Form
Form 8 Thoracic Heart Lung Adult Post 5 OPTN- Thoracic Follow-up	Form
Form 11 Thoracic Heart Lung Pediatric Post 5 OPTN- Thoracic Follow-up	Form
Form 13 Thoracic Lung Adult 6 month Follow UP OPTN- Thoracic Follow-up	Form
Form 14 Thoracic Lung Adult Post 5 Follow Up OPTN- Thoracic Follow-up	Form
Form 17 Thoracic Lung Pediatric Post 5 OPTN- Thoracic Follow-up	Form
Form 3 Thoracic Heart Adult Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 4 Thoracic Heart Pediatric 6 Month Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 6 Thoracic Heart Pediatric Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 9 Thoracic Heart Lung Adult Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 10 Thoracic Heart Lung Pediatric 6 Month Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 12 Thoracic Heart Lung Pediatric Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 15 Thoracic Lung Adult Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 16 Thoracic Lung Pediatric 6 Month Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
Form 18 Thoracic Lung Pediatric Transplant Recipient Follow Up OPTN- Thoracic Follow-up	Form
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: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Yes	Yes	Fillable Fileable
Form	2	Yes	Yes	Fillable Fileable
Form	5	Yes	Yes	Fillable Fileable
Form	7	Yes	Yes	Fillable Fileable
Form	8	Yes	Yes	Fillable Fileable
Form	11	Yes	Yes	Fillable Fileable
Form	13	Yes	Yes	Fillable Fileable
Form	14	Yes	Yes	Fillable Fileable
Form	17	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Form	3	Yes	Yes	Fillable Fileable
Form	4	Yes	Yes	Fillable Fileable
Form	6	Yes	No	Fillable Fileable
Form	9	Yes	Yes	Fillable Fileable
Form	10	Yes	Yes	Fillable Fileable
Form	12	Yes	Yes	Fillable Fileable
Form	15	Yes	Yes	Fillable Fileable
Form	16	Yes	Yes	Fillable Fileable
Form	18	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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-36,287	36,287
Annual IC Time Burden (Hours)	-23,587	23,587
Annual IC Cost Burden (Dollars)	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.

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