4 Donor Histocompatibility_Form.xlsx

Data System for Organ Procurement and Transplantation Network

Donor Histocompatibility_Form.xlsx

Donor Histocompatibility Form

OMB: 0915-0157

Document [xlsx]
Download: xlsx | pdf



Donor Histocompatibility (DHS)



Fields to be completed by members







Form Section Field Label Notes



Provider Information Lab Center Code Display Only - Cascades from Database



Provider Information Lab Center Type Display Only - Cascades from Database



Provider Information OPO Center Code Display Only - Cascades from Database



Provider Information OPO Center Type Display Only - Cascades from Database



Donor Information UNOS Donor ID//UNOS Donor ID # Display Only - Cascades from feedback



Donor Information Donor Type Display Only - Cascades from feedback



Donor Typing Donor HLA Typed



Donor Typing Date Typing Complete Class I



Donor Typing Target Source for Class I




Typing Method Class I



Typing Method Class I A



Typing Method Class I A



Typing Method Class I B



Typing Method Class I B



Typing Method Class I Bw4



Typing Method Class I Bw6



Typing Method Class I Cw



Typing Method Class I Cw



Donor Typing Date Typing Complete Class II



Donor Typing Target Source for Class II



Typing Method Class II Typing Method Class II



Typing Method Class II DR



Typing Method Class II DR



Typing Method Class II DR51



Typing Method Class II DR52



Typing Method Class II DR53



Typing Method Class II DQB



Typing Method Class II DQB



Typing Method Class II DQA



Typing Method Class II DQA



Typing Method Class II DPB



Typing Method Class II DPB



Typing Method Class II DPA



Typing Method Class II DPA



Living Donor Information Living Recipient Last Name Display Only - Cascades from Database



Living Donor Information Living Recipient First Name Display Only - Cascades from Database



Living Donor Information/File Layout SSN Display Only - Cascades from Database



Living Donor Information Organ Display Only - Cascades from Database



Living Donor Information Transplant Date Display Only - Cascades from Database



Living Donor Information Transplant Center Display Only - Cascades from Database





















PUBLIC BURDEN STATEMENT:




The private, non-profit Organ Procurement and Transplantation Network (OPTN) collects this information in order to perform the following OPTN functions: to assess whether applicants meet OPTN Bylaw requirements for membership in the OPTN; and to monitor compliance of member organizations with OPTN Obligations. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0157 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit per 42 CFR §121.11(b)(2). All data collected will be subject to Privacy Act protection (Privacy Act System of Records #09-15-0055). Data collected by the private non-profit OPTN also are well protected by a number of the Contractor’s security features. The Contractor’s security system meets or exceeds the requirements as prescribed by OMB Circular A-130, Appendix III, Security of Federal Automated Information Systems, and the Departments Automated Information Systems Security Program Handbook. The public reporting burden for this collection of information is estimated to average 0.7 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].








































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