Information Collection

Scientific Registry of Transplant Recipients Information Collection Effort for Potential Donors for Living Organ Donation

IC 228713 under ICR 201710-0906-001 · OMB 0906-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0034 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Scientific Registry of Transplant Recipients Information Collection Effort for Potential Donors for Living Organ Donation	Form
2 SRTR Candidate Reasons Did Not Donate_Liver and Kidney F SRTR Candidate Reasons Did Not Donate_Liver and Kidney Form_10-11-17.docx	Form
3 SRTR Form Potential Living Donor Follow-up Form_1 yr_10- SRTR Form Potential Living Donor Follow-up Form_1 yr_10-11-17.docx	Form
1 SRTR Initial Registration Worksheet_20171208_updates.doc SRTR Initial Registration Worksheet_20171208_updates.docx	Form

IC Title:

Scientific Registry of Transplant Recipients Information Collection Effort for Potential Donors for Living Organ Donation

Agency IC Tracking Number:

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	SRTR Candidate Reasons Did Not Donate_Liver and Kidney Form_10-11-17.docx	SRTR Candidate Reasons Did Not Donate_Liver and Kidney Form_10-11-17.docx	Yes	Yes	Fillable Fileable
Form	3	SRTR Form Potential Living Donor Follow-up Form_1 yr_10-11-17.docx	SRTR Form Potential Living Donor Follow-up Form_1 yr_10-11-17.docx	Yes	Yes	Fillable Fileable
Form	1	SRTR Initial Registration Worksheet_20171208_updates.docx	SRTR Initial Registration Worksheet_20171208_updates.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 804

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	804	804
Annual IC Time Burden (Hours)	1,358	1,358
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.