Organ Procurement and Transplantation Network Application Form

ICR 202106-0915-002

OMB: 0915-0184

Federal Form Document

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Supplementary Document
2021-06-02
Supplementary Document
2021-06-02
Justification for No Material/Nonsubstantive Change
2021-06-02
Supporting Statement A
2020-06-26
Supplementary Document
2020-06-26
Supplementary Document
2020-06-26
Supplementary Document
2020-06-26
IC Document Collections
IC ID
Document
Title
Status
226701 Unchanged
226700 Unchanged
226699 Unchanged
226698 Unchanged
226695 Unchanged
226694 Unchanged
226693 Unchanged
226692 Unchanged
226689 Unchanged
226687 Unchanged
226686 Unchanged
226685 Unchanged
226684 Unchanged
226683 Unchanged
226682 Unchanged
226681 Unchanged
226680 Unchanged
ICR Details
0915-0184 202106-0915-002
Received in OIRA 202006-0915-007
HHS/HSA 21566
Organ Procurement and Transplantation Network Application Form
No material or nonsubstantive change to a currently approved collection   No
Regular 06/02/2021
  Requested Previously Approved
08/31/2023 08/31/2023
1,661 1,661
4,755 4,755
0 0

This is a request for OMB approval for revisions of the application documents used to collect information for determining if the interested party is compliant with membership requirements contained in the final rule Governing the Operation of the Organ Procurement and Transplantation Network (OPTN), (42 CFR part 121) ‘‘the OPTN final rule.’’ Respondents include: hospitals seeking to perform organ transplants, non-profit organizations seeking to become an organ procurement organization, and medical laboratories seeking to become an OPTN-approved histocompatibility laboratory.

US Code: 42 USC 273 Name of Law: National Organ Transplant Act of 1984
   US Code: 42 USC 1138 Name of Law: Hospital Protocols for Organ Procurement and Standards for Organ Procurement Agencies
  
None

Not associated with rulemaking

  85 FR 8300 02/13/2020
85 FR 38380 06/26/2020
No

17
IC Title Form No. Form Name
OPTN Business Membership Application 16 Membership_Business Form.docx
OPTN Certificate of Assessment and Program Coverage Plan Membership Application 2 Membership_CertificateAssessment_ProgramCoverage Form.docx
OPTN Individual Membership Application 17 Membership_Individual Form.docx
OPTN Medical Scientific Membership Application 14 Membership_MedicalScientific Form.docx
OPTN Membership Application Islet Transplant Program 8, 8B Membership_Pancreas Islet Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application 9B, 9 Membership_VCA Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Heart Transplant Program 6, 6B Membership_Heart Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Histocompatibility Labs 12 Membership_HistoLab Form.docx
OPTN Membership Application for Intestine Transplant Programs 10, 10B Membership_Intestine Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Kidney Transplant Programs 3 , 3B Membership_Kidney_LDKidney Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Liver Transplant Progrms 4, 4B Membership_Liver_LDLiver Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Lung Transplant Program 7B, 7 Membership_Lung Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for OPOs 11 Membership_OPO Form.docx
OPTN Membership Application for Pancreas Transplant Programs 5B, 5 Membership_Pancreas Form.docx ,   Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Transplant Hospitals 1 Membership_Transplant Hospital_General Form.docx
OPTN Public Organization Membership Application 15 Membership_PublicOrg Form.docx
OPTN Representative Form 13 Membership_Representative Form.docx

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,661 1,661 0 0 0 0
Annual Time Burden (Hours) 4,755 4,755 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Burden decrease due to less forms and less average burden per response; burden increase due to an increase in respondents.

$345,000
No
    No
    No
No
No
No
No
Elyana Bowman 301 443-3983 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/02/2021


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