A New Transplant Hospital Program Application - General

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⚠️ Notice: This information collection may be referencing outdated material.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 A1 A New Transplant Hospital Program Application - General Form and Instruction
A1 A1_NewTransplantHospital_Cover_HRSA.doc A1_NewTransplantHospital_Cover_HRSA.doc Form and Instruction
A2 A2_NewTransplant_General_Clean.doc A2_NewTransplant_General_Clean.doc Form and Instruction
B1 B1_NewTransplantProgram_Cover_Clean_HRSA.doc B1_NewTransplantProgram_Cover_Clean_HRSA.doc Form and Instruction
B2 B2 VCA_NewTransplantProgram_Cover_HRSA.doc M1_VCA_NewTransplantProgram_Cover_HRSA.doc Form and Instruction

Information Collection (IC) Details

IC Title:	A New Transplant Hospital Program Application - General	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	A1	A1_NewTransplantHospital_Cover_HRSA.doc	A1_NewTransplantHospital_Cover_HRSA.doc	Yes	Yes	Fillable Fileable
Form and Instruction	A2	A2_NewTransplant_General_Clean.doc	A2_NewTransplant_General_Clean.doc	Yes	Yes	Fillable Printable
Form and Instruction	B1	B1_NewTransplantProgram_Cover_Clean_HRSA.doc	B1_NewTransplantProgram_Cover_Clean_HRSA.doc	Yes	Yes	Fillable Fileable
Form and Instruction	B2	B2 VCA_NewTransplantProgram_Cover_HRSA.doc	M1_VCA_NewTransplantProgram_Cover_HRSA.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	16	16
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.