Heart Transplant Recipient Follow Up Post 5 Year

Data System for Organ Procurement and Transplantation Network

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.