Information Collection

A New Transplant Hospital Program Application - General

IC 226680 under ICR 201802-0915-002 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

A New Transplant Hospital Program Application - General

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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 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 %

table that charts list of burden
	Approved	Previously Approved
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

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.