Information Collection

Heart/Lung Post Transplant Malignancy (PTM) Form

IC 226431 under ICR 201905-0915-005 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Post Transplant Maligancy_PTM_Instructions.docx	Instruction
23 Post Transplant Malignancy Form_All Organs.xlsx Post Transplant Malignancy Form_All Organs.xlsx	Form

IC Title:

Heart/Lung Post Transplant Malignancy (PTM) Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Post Transplant Maligancy_PTM_Instructions.docx		Yes	Yes	Fillable Fileable
Form	23	Post Transplant Malignancy Form_All Organs.xlsx	Post Transplant Malignancy Form_All Organs.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 68

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	21	21
Annual IC Time Burden (Hours)	8	8
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.