Information Collection

OPTN Membership Application for Intestine Transplant Programs

IC 226692 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⚠️ Notice: This information collection may be referencing outdated material.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 10 OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
10 Membership_Intestine Form.docx Membership_Intestine Form.docx	Form and Instruction
10B Membership_SurgeonOrPhysicianLog Form.docx Membership_SurgeonOrPhysicianLog Form.docx	Form and Instruction
10 OPTN Membership Application for Intestine Transplant Pro OPTN Membership Application for Intestine Transplant Programs CLEAN.docx	Form and Instruction
10 R OPTN Membership Application for Intestine Transplant Pro OPTN Membership Application for Intestine Transplant Programs REDLINE.docx	Form and Instruction
10 B OPTN Membership Application_Surgeon or Physician Log CLE OPTN Membership Application_Surgeon or Physician Log CLEAN.docx	Form and Instruction
10 BR OPTN Membership Application_Surgeon or Physician Log RED OPTN Membership Application_Surgeon or Physician Log REDLINE.docx	Form and Instruction

IC Title:

OPTN Membership Application for Intestine Transplant 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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10	OPTN Membership Application for Intestine Transplant Programs CLEAN	OPTN Membership Application for Intestine Transplant Programs CLEAN.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10 R	OPTN Membership Application for Intestine Transplant Programs REDLINE	OPTN Membership Application for Intestine Transplant Programs REDLINE.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10 B	OPTN Membership Application_Surgeon or Physician Log CLEAN	OPTN Membership Application_Surgeon or Physician Log CLEAN.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10 BR	OPTN Membership Application_Surgeon or Physician Log REDLINE	OPTN Membership Application_Surgeon or Physician Log 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: 90

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	540	540
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.