OPTN Personnel Change Application

Organ Procurement and Transplantation Network Application Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Document Name Document Type
Form E OPTN Personnel Change Application Form and Instruction
E Personnel Change Application (Transplant Program) E_PersonnelChange_Cover.doc Form and Instruction
F Change in Key Personnel Application - Histocompatibility F_HistoLab_DirectorChange.doc Form and Instruction
G Application for Approval for Change in Key Personnel - O G_OPO_DirectorChange.doc Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Personnel Change Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 121

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	E	Personnel Change Application (Transplant Program)	E_PersonnelChange_Cover.doc	Yes	Yes	Fillable Fileable
Form and Instruction	F	Change in Key Personnel Application - Histocompatibility Laboratory	F_HistoLab_DirectorChange.doc	Yes	Yes	Fillable Printable
Form and Instruction	G	Application for Approval for Change in Key Personnel - OPO	G_OPO_DirectorChange.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 395	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-772	772
Annual IC Time Burden (Hours)	-3,042	3,042
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.