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⚠️ Notice: This information collection may be referencing outdated material.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
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.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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
Instruction			Thoracic Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Form	3	Thoracic Heart Adult Transplant Recipient Follow Up	Thoracic_Heart_Adult_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	6	Thoracic Heart Pediatric Transplant Recipient Follow Up	Thoracic_Heart_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Yes	No	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	15	Thoracic Lung Adult Transplant Recipient Follow Up	Thoracic_Lung_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	18	Thoracic Lung Pediatric Transplant Recipient Follow Up	Thoracic_Lung_Pediatric_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

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