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B VCA Abdominal Wall Designated Program Application
Organ Procurement and Transplantation Network Application Form
OMB: 0915-0184
IC ID: 226690
OMB.report
HHS/HSA
OMB 0915-0184
ICR 201802-0915-002
IC 226690
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:
2024-10-08 - No material or nonsubstantive change to a currently approved collection
2023-10-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form B12
B VCA Abdominal Wall Designated Program Application
Form and Instruction
B12 B12 VCA_AW_Kidney_Updated.doc
M3_VCA_AW_Kidney_Updated.doc
Form and Instruction
B13 B13 VCA_AW_Liver_Updated.doc
M4_VCA_AW_Liver_Updated.doc
Form and Instruction
B14 B14 _VCA_AW_Pancreas_Updated.doc
M5_VCA_AW_Pancreas_Updated.doc
Form and Instruction
B15 B15 VCA_AW_Intestine_Updated.doc
M2_VCA_AW_Intestine_Updated.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
B VCA Abdominal Wall Designated Program Application
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
B12
B12 VCA_AW_Kidney_Updated.doc
M3_VCA_AW_Kidney_Updated.doc
Yes
Yes
Fillable Fileable
Form and Instruction
B13
B13 VCA_AW_Liver_Updated.doc
M4_VCA_AW_Liver_Updated.doc
Yes
Yes
Fillable Fileable
Form and Instruction
B14
B14 _VCA_AW_Pancreas_Updated.doc
M5_VCA_AW_Pancreas_Updated.doc
Yes
Yes
Fillable Fileable
Form and Instruction
B15
B15 VCA_AW_Intestine_Updated.doc
M2_VCA_AW_Intestine_Updated.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
13
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
26
0
0
0
0
26
Annual IC Time Burden (Hours)
78
0
0
0
0
78
Annual IC Cost Burden (Dollars)
0
0
0
0
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.