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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.