Information Collection

Heart, Lung, Heart/Lung Follow Up (Post 5 year)

IC 214128 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⚠️ Notice: This information collection may be referencing outdated material.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 22 Heart, Lung, Heart/Lung Follow Up (Post 5 year)	Form and Instruction
22 Heart, Lung, Heart/Lung Follow Up (Post 5 year) 22 Thoracic Post 5 Year Transplant Recipient Follow HR_LU_HL_Instructions.docx	Form and Instruction

IC Title:

Heart, Lung, Heart/Lung Follow Up (Post 5 year)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	22	Heart, Lung, Heart/Lung Follow Up (Post 5 year)	22 Thoracic Post 5 Year Transplant Recipient Follow HR_LU_HL_Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 259

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
Annual Number of Responses for this IC	19,485	19,485
Annual IC Time Burden (Hours)	11,691	11,691
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.