Information Collection

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

IC 228713 under ICR 201910-0906-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	Approved	Previously Approved
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

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.