Information Collection Request

Organ Procurement and Transplantation Network Application Form

ICR 201906-0915-004 · OMB 0915-0184 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form K K Individual Member Application Form and Instruction Unchanged Repair queued
Form j J Business Member Application Form and Instruction Unchanged Available
Form I I Public Org Application Form and Instruction Unchanged Repair queued
Form H H Medical Scientific Org Application Form and Instruction Unchanged Available
Form G G Change in OPO Key Personnel Form and Instruction Unchanged Repair queued
Form F F Change in Histocompatibility Lab Director Form and Instruction Unchanged Repair queued
Form F E Personnel Change Cover Application Form and Instruction Unchanged Repair queued
Form D D Histocompatibility Lab Application Form and Instruction Unchanged Repair queued
Form C C OPO New Application Form and Instruction Unchanged Available
Form B17 B Intestine Designated Program Application Form and Instruction Unchanged Repair queued
Form B16 a B VCA Other Designated Program Application Form and Instruction Unchanged Repair queued
Form B12 B VCA Abdominal Wall Designated Program Application Form and Instruction Unchanged Available
Form B11 B VCA Upper Limb Designated Program Application Form and Instruction Unchanged Repair queued
Form B10 B VCA Head and Neck Designated Program Application Form and Instruction Unchanged Available
Form B9 B Living Donor (LD) Recovery Program Application Form and Instruction Unchanged Available
Form B8 B Islet (PI) Designated Program Application Form and Instruction Unchanged Available
Form B7 B Lung (LU) Designated Program Application Form and Instruction Unchanged Available
Form B6 B Heart (HR) Designated Program Application Form and Instruction Unchanged Available
Form B5 B Pancreas (PA) Designated Program Application Form and Instruction Unchanged Repair queued
Form B4 B Liver (LI) Designated Program Application Form and Instruction Unchanged Available
Form B3 B Kidney (KI) Designated Program Application Form and Instruction Unchanged Available
Form A1 A New Transplant Hospital Program Application - General Form and Instruction Unchanged Available
Change Memo - Pediatric Component.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-06-04 Repair queued
B7_Lung_Final track changes.doc Justification for No Material/Nonsubstantive Change Uploaded 2019-06-04 Available
B6_Heart_Final track changes.doc Justification for No Material/Nonsubstantive Change Uploaded 2019-06-04 Repair queued
B5_Pancreas_Final track changes.doc Justification for No Material/Nonsubstantive Change Uploaded 2019-06-04 Repair queued
B4_Liver_LDL_Final track changes.doc Justification for No Material/Nonsubstantive Change Uploaded 2019-06-04 Repair queued
B3_Kidney_LDK_Final track changes.doc Justification for No Material/Nonsubstantive Change Uploaded 2019-06-04 Repair queued
20180209 Attachment A OPTN B10 Intestine Form.doc Supplementary Document Uploaded 2018-02-27 Repair queued
OMB 0915-0184 Supporting Statement A rev 05012017.docx Supporting Statement A Uploaded 2017-05-03 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
226701 K Individual Member Application Form and Instruction Unchanged
226700 J Business Member Application Form and Instruction Unchanged
226699 I Public Org Application Form and Instruction Unchanged
226698 H Medical Scientific Org Application Form and Instruction Unchanged
226697 G Change in OPO Key Personnel Form and Instruction Unchanged
226696 F Change in Histocompatibility Lab Director Form and Instruction Unchanged
226695 E Personnel Change Cover Application Form and Instruction Unchanged
226694 D Histocompatibility Lab Application Form and Instruction Unchanged
226693 C OPO New Application Form and Instruction Unchanged
226692 B Intestine Designated Program Application Form and Instruction Unchanged
226691 B VCA Other Designated Program Application Form and Instruction Unchanged
226690 B VCA Abdominal Wall Designated Program Application Form and Instruction Unchanged
226689 B VCA Upper Limb Designated Program Application Form and Instruction Unchanged
226688 B VCA Head and Neck Designated Program Application Form and Instruction Unchanged
226687 B Living Donor (LD) Recovery Program Application Form and Instruction Unchanged
226686 B Islet (PI) Designated Program Application Form and Instruction Unchanged
226685 B Lung (LU) Designated Program Application Form and Instruction Unchanged
226684 B Heart (HR) Designated Program Application Form and Instruction Unchanged
226683 B Pancreas (PA) Designated Program Application Form and Instruction Unchanged
226682 B Liver (LI) Designated Program Application Form and Instruction Unchanged
226681 B Kidney (KI) Designated Program Application Form and Instruction Unchanged
226680 A New Transplant Hospital Program Application - General Form and Instruction Unchanged
ICR Details
0915-0184 201906-0915-004
Historical Active 201802-0915-002
HHS/HSA 21566
Organ Procurement and Transplantation Network Application Form
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/05/2019
Retrieve Notice of Action (NOA) 06/05/2019
  Inventory as of this Action Requested Previously Approved
07/31/2020 07/31/2020 07/31/2020
1,868 0 1,868
7,020 0 7,020
0 0 0

A question regarding designated intestine transplant programs was inadvertently omitted from the OPTN membership application forms approved by the Office of Management and Budget during July 2017. Specifically, the omitted question is used to collect information to demonstrate compliance with the intestine transplant program “primary transplant physician” training and experience requirements in the OPTN bylaws.

US Code: 42 USC 274 Name of Law: Organ Procurement and Transplantation Network
   US Code: 42 USC 273 Name of Law: National Organ Transplant Act
   US Code: 42 USC 1138 Name of Law: Hospital Protocols for Organ Procurement and Standards for Organ Procurement Agencies
  
None

Not associated with rulemaking

  81 FR 89115 12/09/2016
82 FR 22145 05/12/2017
No

22
IC Title Form No. Form Name
B Intestine Designated Program Application B17 B17 Intestine_HRSA.doc
D Histocompatibility Lab Application D D_HistoLab_New_Clean_HRSA.doc
I Public Org Application I I_PublicOrg_Clean_HRSA.doc
B Heart (HR) Designated Program Application B6 B6_HR Heart_Clean.doc
B Living Donor (LD) Recovery Program Application B9 B9_LD NewLivingDonorRecoveries_Clean.doc
B VCA Upper Limb Designated Program Application B11 B VCA_Upper Limb_Updated.doc
C OPO New Application C C_OPO_New_final_Clean_HRSA.doc
E Personnel Change Cover Application F F_HistoLab_PersonnelChange_Clean_HRSA.doc
F Change in Histocompatibility Lab Director F F_HistoLab_PersonnelChange_Clean_HRSA.doc
G Change in OPO Key Personnel G G_OPO_DirectorChange_final_clean_HRSA.doc
H Medical Scientific Org Application H H_MedicalScientific_Clean_HRSA.doc
J Business Member Application j J_Business_Clean_HRSA.doc
K Individual Member Application K K_Individual_Clean_HRSA.doc
B VCA Abdominal Wall Designated Program Application B12, B13, B14, B15 B12 VCA_AW_Kidney_Updated.doc ,   B13 VCA_AW_Liver_Updated.doc ,   B14 _VCA_AW_Pancreas_Updated.doc ,   B15 VCA_AW_Intestine_Updated.doc
B VCA Other Designated Program Application B16 c, B16 a, B16 b B16 a VCA_Other_Updated.doc ,   B16 b VCA_Other_NewTransplantProgram_Cover_HRSA.doc_.doc ,   B16 c VCA_Other_PersonnelChange_Cover_HRSA.doc_.doc
B Kidney (KI) Designated Program Application B3 B3_Kidney_LDKidney_Clean.doc
B Liver (LI) Designated Program Application B4 B4_L1 Liver_LDLiver_Clean.doc
B Pancreas (PA) Designated Program Application B5 B5_PA Pancreas_Clean.doc
A New Transplant Hospital Program Application - General B2, A2, B1, A1 A1_NewTransplantHospital_Cover_HRSA.doc ,   A2_NewTransplant_General_Clean.doc ,   B1_NewTransplantProgram_Cover_Clean_HRSA.doc ,   B2 VCA_NewTransplantProgram_Cover_HRSA.doc
B Lung (LU) Designated Program Application B7 B7_LU Lung_Clean.doc
B Islet (PI) Designated Program Application B8 B8_PI PancreasIslet_Clean.doc
B VCA Head and Neck Designated Program Application B10 B VCA_Head and Neck_Updated.doc

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,868 1,868 0 0 0 0
Annual Time Burden (Hours) 7,020 7,020 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The estimated burden for the revised collection increased from 6,006 to 7,016. This increase is due to the additions and revisions to selected forms and the addition of new forms around VCA transplants. However, each individual form will be shorter and easier to complete, leading to a decrease in burden in some instruments. ROCIS doesn't allow for 0 respondents or burden, so the respondents had to be increased to 1 in order to be entered. This caused the total respondents to increase by 1 and the total burden by 4 hours. Form C "OPO New Applications" has 0 for respondents as there are no new respondents, thus no form to respond to.

$345,000
No
    No
    No
No
No
No
Uncollected
Elyana Bowman 301 443-3983 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/05/2019