Information Collection

OPTN- Kidney/Pancreas Follow-up

IC 181744 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⚠️ Notice: This information collection may be referencing outdated material.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
Kidney-Pancreas Post 5 Year Transplant Recipient Follow Up Instructions.pdf	Instruction
Kidney-Pancreas Transplant Recipient Follow Up Instructions.pdf	Instruction
20 Kidney-Pancreas Adult Post 5 Year Transplant Recipient F Kidney-Pancreas Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Form
20b Kidney-Pancreas Adult Transplant Recipient Follow Up Wor Kidney-Pancreas Adult Transplant Recipient Follow Up Worksheet.pdf	Form
20c Kidney-Pancreas Pediatric Post 5 Year Transplant Recipie Kidney-Pancreas Pediatric Post 5 Year Transplant Recipient Follow Up Workshseet.pdf	Form
20d Kidney-Pancreas Pediatric Transplant Recipient Follow Up Kidney-Pancreas_Pediatric_Transplant_Recipient_Follow_Up_Worksheet[1].pdf	Form

IC Title:

OPTN- Kidney/Pancreas 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			Kidney-Pancreas Post 5 Year Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Instruction			Kidney-Pancreas Transplant Recipient Follow Up Instructions.pdf	Yes	No	Printable Only
Form	20	Kidney-Pancreas Adult Post 5 Year Transplant Recipient Follow Up Worksheet	Kidney-Pancreas Adult Post 5 Year Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	20b	Kidney-Pancreas Adult Transplant Recipient Follow Up Worksheet	Kidney-Pancreas Adult Transplant Recipient Follow Up Worksheet.pdf	Yes	Yes	Fillable Fileable
Form	20c	Kidney-Pancreas Pediatric Post 5 Year Transplant Recipient Follow Up Workshseet	Kidney-Pancreas Pediatric Post 5 Year Transplant Recipient Follow Up Workshseet.pdf	Yes	Yes	Fillable Fileable
Form	20d	Kidney-Pancreas Pediatric Transplant Recipient Follow Up Worksheet	Kidney-Pancreas_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: 144

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	-10,800	10,800
Annual IC Time Burden (Hours)	-9,180	9,180
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.