OPTN Membership Application for Pancreas Transplant Programs

Organ Procurement and Transplantation Network Application Form

OMB: 0915-0184

IC ID: 226683

Information Collection (IC) Details

View Information Collection (IC)

OPTN Membership Application for Pancreas Transplant Programs
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 5 Membership_Pancreas Form.docx Membership_Pancreas Form.docx Yes Yes Fillable Fileable
Form and Instruction 5B Membership_SurgeonOrPhysicianLog Form.docx Membership_SurgeonOrPhysicianLog Form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

120 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 240 0 120 0 0 120
Annual IC Time Burden (Hours) 720 0 240 0 0 480
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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