The OPTN recommends changes to
existing OMB approved forms, as well as the addition of 5 new forms
for capturing new VCA and Intestine designated transplant program
applications. This is a request for OMB approval for additions and
revisions to the information collection activities for the
application and membership requirements. This packet contains the
membership application documents used to collect information
required for membership in the OPTN. These materials are needed in
the format submitted to allow for verification that applicants meet
OPTN obligations or to document that an application does not
qualify for OPTN membership. Respondents include hospitals
interested in providing transplant services, histocompatibility
laboratories, organ procurement organizations, individuals and
organizations that wish to participate in the OPTN.
US Code:
42
USC 1138 Name of Law: Hospital Protocols for Organ Procurement
and Standards for Organ Procurement Agencies
US Code: 42
USC 274 Name of Law: Organ Procurement and Transplantation
Network
US Code: 42
USC 273 Name of Law: National Organ Transplant Act
The estimated burden for the
revised collection increased from 6,006 to 7,016. This increase is
due to the additions and revisions to selected forms and the
addition of new forms around VCA transplants. However, each
individual form will be shorter and easier to complete, leading to
a decrease in burden in some instruments. ROCIS doesn't allow for 0
respondents or burden, so the respondents had to be increased to 1
in order to be entered. This caused the total respondents to
increase by 1 and the total burden by 4 hours. Form C "OPO New
Applications" has 0 for respondents as there are no new
respondents, thus no form to respond to.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form B5 Organ Procurement and Transplantation Network Application
OMB 0915-0184 Supporting Statement A rev 05012017.docx
Organ Procurement and Transplantation Network Application