Information Collection

Heart Transplant Recipient Follow Up Post 5 Year

IC 226418 under ICR 202006-0915-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 10 Heart Transplant Recipient Follow Up Post 5 Year	Form
Heart Transplant Recipient Follow Up Post 5 Year_Instructions.docx	Instruction
10 Heart Transplant Recipient Follow Up Post 5 Year_Form.CL 05.12.2020 Heart Transplant Recipient Follow Up Post 5 Year_Form.CLEAN.xlsx .xlsx	Form

IC Title:

Heart Transplant Recipient Follow Up Post 5 Year

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	10	Heart Transplant Recipient Follow Up Post 5 Year_Form.CLEAN.xlsx	05.12.2020 Heart Transplant Recipient Follow Up Post 5 Year_Form.CLEAN.xlsx .xlsx		Yes	Yes	Fillable Fileable
Instruction			Heart Transplant Recipient Follow Up Post 5 Year_Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	21,556	5,471	16,085
Annual IC Time Burden (Hours)	10,778	2,735	8,043
Annual IC Cost Burden (Dollars)	0	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.