Information Collection

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

IC 228713 under ICR 202012-0906-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 and Instruction
1 Living Donor Registration Form 11.20.2020 Living Donor Registration Form - SRTR 0906-0034.docx Form and Instruction
1 Living Donor Registration Form 11.20.2020 Living Donor Registration Form - SRTR 0906-0034.docx Form and Instruction
2 Potential Living Donor Follow-Up Form 11.20.2020 Potential Living Donor Follow-Up Form - SRTR 0906-0034.docx Form and Instruction
2 Potential Living Donor Follow-Up Form 11.20.2020 Potential Living Donor Follow-Up Form - SRTR 0906-0034.docx Form and Instruction
3 Reasons Did Not Donate Form 11.20.2020 Reasons Did Not Donate Form - SRTR 0906-0034.docx Form and Instruction
3 Reasons Did Not Donate Form 11.20.2020 Reasons Did Not Donate Form - SRTR 0906-0034.docx Form and Instruction

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 and Instruction	1	Living Donor Registration Form	11.20.2020 Living Donor Registration Form - SRTR 0906-0034.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Potential Living Donor Follow-Up Form	11.20.2020 Potential Living Donor Follow-Up Form - SRTR 0906-0034.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Reasons Did Not Donate Form	11.20.2020 Reasons Did Not Donate Form - SRTR 0906-0034.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 786	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,242	3,438	804
Annual IC Time Burden (Hours)	1,251	-107	1,358
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.