Information Collection

HRSA Division of Transplanation (DoT Research on Customer Information Needs Related to Vascularized Composite Allographs Transplants

IC 216834 under ICR 201502-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 HRSA Division of Transplanation (DoT Research on Customer Information Needs Related to Vascularized Composite Allographs Transplants	Form and Instruction
1 Focus Groups on VCA Donation VCA_FG_Guide_3-24.15.docx	Form and Instruction
2 Survey on VCA Donation VCA_Survey.doc	Form and Instruction
VCA SupportingStatement.docx VCA Supporting Statement	IC Document
Attachment1_FG_Informed Consent DoT.doc.doc Informed Consent	IC Document
Attachment2_VCA-omb recruitmt script DoT.doc.doc Recruitment Script Screener	IC Document

IC Title:

HRSA Division of Transplanation (DoT Research on Customer Information Needs Related to Vascularized Composite Allographs Transplants

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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	2	Survey on VCA Donation	VCA_Survey.doc		Yes	Yes	Fillable Fileable
Form and Instruction	1	Focus Groups on VCA Donation	VCA_FG_Guide_3-24.15.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 724

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	724	724
Annual IC Time Burden (Hours)	174	174
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
VCA Supporting Statement	VCA SupportingStatement.docx	06/01/2015
Informed Consent	Attachment1_FG_Informed Consent DoT.doc.doc	06/01/2015
Recruitment Script Screener	Attachment2_VCA-omb recruitmt script DoT.doc.doc	06/01/2015

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