Information Collection

OPTN Membership Application for Transplant Hospitals and Programs

IC 226680 under ICR 202106-0915-002 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 OPTN Membership Application for Transplant Hospitals	Form and Instruction
1 Membership_Transplant Hospital_General Form.docx Membership_TransplantHospital_General Form.docx	Form and Instruction
1 OPTN Membership Application for Transplant Hospitals and OPTN Membership Application for Transplant Hospitals and Programs CLEAN.docx	Form and Instruction
1 R OPTN Membership Application for Transplant Hospitals and OPTN Membership Application for Transplant Hospitals and Programs REDLINE.docx	Form and Instruction

IC Title:

OPTN Membership Application for Transplant Hospitals and Programs

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	1	OPTN Membership Application for Transplant Hospitals and Programs CLEAN.docx	OPTN Membership Application for Transplant Hospitals and Programs CLEAN.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1 R	OPTN Membership Application for Transplant Hospitals and Programs REDLINE.docx	OPTN Membership Application for Transplant Hospitals and Programs REDLINE.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

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	Previously Approved
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	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.