Information Collection

Baseline Pre-TED (Transplant Essential Data)

IC 180280 under ICR 202109-0915-001 · OMB 0915-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1A Baseline Pre-TED (Transplant Essential Data)	Form
FORM 1 - 2400 R9.docx	Other-changes/adds in blue highlight
FORM 1 - 2400 R9.docx	Other-changes/adds in blue highlight
1A PandemicImpactTemplate.xlsx PRE-TED PandemicImpactTemplate.xlsx	Form
1A PandemicImpactTemplate.xlsx PRE-TED PandemicImpactTemplate.xlsx	Form
1B FORM 1 - 2400 R8.pdf FORM 1 - 2400 R8.pdf	Form
1B FORM 1 - 2400 R8.pdf FORM 1 - 2400 R8.pdf	Form

IC Title:

Baseline Pre-TED (Transplant Essential Data)

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	1A	PandemicImpactTemplate.xlsx PRE-TED	PandemicImpactTemplate.xlsx	Yes	Yes	Fillable Fileable
Form	1B	FORM 1 - 2400 R8.pdf	FORM 1 - 2400 R8.pdf	Yes	Yes	Fillable Fileable
Other-changes/adds in blue highlight			FORM 1 - 2400 R9.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	9,600	0	9,600
Annual IC Time Burden (Hours)	6,720	160	6,560
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.