Information Collection

Baseline Pre-TED (Transplant Essential Data)

IC 180280 under ICR 202004-0915-001 · OMB 0915-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Baseline Pre-TED (Transplant Essential Data)	Form
1 CLEAN PRE-TED UPDTD 4-7-20 04.03.2020 Clean Form OMB 0915-0310 PRE-TED (03Apr2020).docx	Form
1 R 04.07.2020 Updated Form PRE-TED REDLINE.docx 04.03.2020 Updated Form PRE-TED REDLINE.docx	Form
03.11.2020 Pre-TED Form 2400 Proposed Changes.docx Proposed Changes Pre-TED Form	IC Document

IC Title:

Baseline Pre-TED (Transplant Essential Data)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	CLEAN PRE-TED UPDTD 4-7-20	04.03.2020 Clean Form OMB 0915-0310 PRE-TED (03Apr2020).docx		Yes	Yes	Fillable Fileable
Form	1 R	04.07.2020 Updated Form PRE-TED REDLINE.docx	04.03.2020 Updated Form PRE-TED REDLINE.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	9,600	9,600
Annual IC Time Burden (Hours)	6,560	6,560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Proposed Changes Pre-TED Form	03.11.2020 Pre-TED Form 2400 Proposed Changes.docx	03/16/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.