Information Collection

Pancreas

IC 181745 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⚠️ Notice: This information collection may be referencing outdated material.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 40 Pancreas	Form and Instruction
40 Pancreas Candidate Registration 40 Pancreas and Pancreas Islets Transplant Candidate Registration_Instructions.docx	Form and Instruction
41 Pancreas Recipient Registration 41 Pancreas Transplant Recipient Registration_Instructions.docx	Form and Instruction
42 Pancreas Recipient Follow Up (6 months - 5 years) 42 Pancreas Transplant Recipient Follow Up_Instructions.docx	Form and Instruction
43 Pancreas Recipient Follow Up (Post 5 years) 43 Pancreas Post 5 Year Transplant Recipient Follow Up_Instructions.docx	Form and Instruction

IC Title:

Pancreas

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	40	Pancreas Candidate Registration	40 Pancreas and Pancreas Islets Transplant Candidate Registration_Instructions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	41	Pancreas Recipient Registration	41 Pancreas Transplant Recipient Registration_Instructions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	42	Pancreas Recipient Follow Up (6 months - 5 years)	42 Pancreas Transplant Recipient Follow Up_Instructions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	43	Pancreas Recipient Follow Up (Post 5 years)	43 Pancreas Post 5 Year Transplant Recipient Follow Up_Instructions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 135

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
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,942	3,366	576
Annual IC Time Burden (Hours)	3,016	2,728	288
Annual IC Cost Burden (Dollars)	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.