61 Potential Disease Transmission Report_Form.xlsx

			Potential Disease Transmission Report
			Fields to be completed by members
			Form Section	Field Label	Notes
			Disease Transmission Event ID & Donor ID	Disease Transmission Event ID
			Disease Transmission Event ID & Donor ID	Donor ID
			PDTR Contact Information - Person Submitting This Report	First Name
			PDTR Contact Information - Person Submitting This Report	Last Name
			PDTR Contact Information - Person Submitting This Report	E-mail
			PDTR Contact Information - Person Submitting This Report	Phone
			Information	The following Suspected Organism/Diseases(s) were reported
			Information	Additional Comments
			Information	As of today, the transmission is
			Information	Date of Recovery
			Status of Infection/Disease in Donor	Donor symptomatic prior to procurement?
			Status of Infection/Disease in Donor	Known at procurement?
			Status of Infection/Disease in Donor	Was an autopsy performed on the donor?
			Status of Infection/Disease in Donor	What type of donor specimen(s)/samples are available for further testing?
			Status of Infection/Disease in Donor	Was the donor blood sample obtained pre- or post-transfusion?
			Status of Infection/Disease in Donor	If the sample was obtained post-transfusion, were hemodilution calculations performed?
			Status of Infection/Disease in Donor	Were all specimens saved for further testing (donor hospital, OPO, and Tx Center)?
			Status of Infection/Disease in Donor	If blood specimens are available on the donor for testing, how much?
			Procuring/Host OPO Contact Information	First Name
			Procuring/Host OPO Contact Information	Last Name
			Procuring/Host OPO Contact Information	Phone
			Procuring/Host OPO Contact Information	Other
			Reporting Status - Public Health Authority Contact Information	Have the public health authorities been contacted?
			Reporting Status - Public Health Authority Contact Information	First Name
			Reporting Status - Public Health Authority Contact Information	Last Name
			Reporting Status - Public Health Authority Contact Information	Phone
			Reporting Status - Public Health Authority Contact Information	Phone Ext
			Assay Test	Was an assay and/or other test used to identify organism/disease?
			Assay Test	Date of Test
			Assay Test	Results
			Assay Test	Assay/Test Type
			Organs - Heart	Organ/Vessels Recovered
			Organs - Heart	Heart
			Organs - Heart	Organ Disposition
			Organs - Heart	Associated Vessels Disposition
			Organs - Heart	Contacted by OPO?
			Organs - Heart	Date Contacted
			Organs - Heart	Center Name
			Organs - Heart	Contact First Name
			Organs - Heart	Contact Last Name
			Organs - Heart	Contact Email
			Organs - Heart	Contact Phone Number
			Organs - Lung - Left	Organ/Vessels Recovered
			Organs - Lung - Left	Lung - Left
			Organs - Lung - Left	Organ Disposition
			Organs - Lung - Left	Associated Vessels Disposition
			Organs - Lung - Left	Contacted by OPO?
			Organs - Lung - Left	Date Contacted
			Organs - Lung - Left	Center Name
			Organs - Lung - Left	Contact First Name
			Organs - Lung - Left	Contact Last Name
			Organs - Lung - Left	Contact Email
			Organs - Lung - Left	Contact Phone Number
			Organs - Lung - Right	Organ/Vessels Recovered
			Organs - Lung - Right	Lung - Right
			Organs - Lung - Right	Organ Disposition
			Organs - Lung - Right	Associated Vessels Disposition
			Organs - Lung - Right	Contacted by OPO?
			Organs - Lung - Right	Date Contacted
			Organs - Lung - Right	Center Name
			Organs - Lung - Right	Contact First Name
			Organs - Lung - Right	Contact Last Name
			Organs - Lung - Right	Contact Email
			Organs - Lung - Right	Contact Phone Number
			Organs - Liver - Whole	Organ/Vessels Recovered
			Organs - Liver - Whole	Liver - Whole
			Organs - Liver - Whole	Organ Disposition
			Organs - Liver - Whole	Associated Vessels Disposition
			Organs - Liver - Whole	Contacted by OPO?
			Organs - Liver - Whole	Date Contacted
			Organs - Liver - Whole	Center Name
			Organs - Liver - Whole	Contact First Name
			Organs - Liver - Whole	Contact Last Name
			Organs - Liver - Whole	Contact Email
			Organs - Liver - Whole	Contact Phone Number
			Organs - Liver - Segment 1	Organ/Vessels Recovered
			Organs - Liver - Segment 1	Liver - Segment 1
			Organs - Liver - Segment 1	Organ Disposition
			Organs - Liver - Segment 1	Associated Vessels Disposition
			Organs - Liver - Segment 1	Contacted by OPO?
			Organs - Liver - Segment 1	Date Contacted
			Organs - Liver - Segment 1	Center Name
			Organs - Liver - Segment 1	Contact First Name
			Organs - Liver - Segment 1	Contact Last Name
			Organs - Liver - Segment 1	Contact Email
			Organs - Liver - Segment 1	Contact Phone Number
			Organs - Liver - Segment 2	Organ/Vessels Recovered
			Organs - Liver - Segment 2	Liver - Segment 2
			Organs - Liver - Segment 2	Organ Disposition
			Organs - Liver - Segment 2	Associated Vessels Disposition
			Organs - Liver - Segment 2	Contacted by OPO?
			Organs - Liver - Segment 2	Date Contacted
			Organs - Liver - Segment 2	Center Name
			Organs - Liver - Segment 2	Contact First Name
			Organs - Liver - Segment 2	Contact Last Name
			Organs - Liver - Segment 2	Contact Email
			Organs - Liver - Segment 2	Contact Phone Number
			Organs - Intestine - Whole	Organ/Vessels Recovered
			Organs - Intestine - Whole	Intestine - Whole
			Organs - Intestine - Whole	Organ Disposition
			Organs - Intestine - Whole	Associated Vessels Disposition
			Organs - Intestine - Whole	Contacted by OPO?
			Organs - Intestine - Whole	Date Contacted
			Organs - Intestine - Whole	Center Name
			Organs - Intestine - Whole	Contact First Name
			Organs - Intestine - Whole	Contact Last Name
			Organs - Intestine - Whole	Contact Email
			Organs - Intestine - Whole	Contact Phone Number
			Organs - Intestine - Segment 1	Organ/Vessels Recovered
			Organs - Intestine - Segment 1	Intestine - Segment 1
			Organs - Intestine - Segment 1	Organ Disposition
			Organs - Intestine - Segment 1	Associated Vessels Disposition
			Organs - Intestine - Segment 1	Contacted by OPO?
			Organs - Intestine - Segment 1	Date Contacted
			Organs - Intestine - Segment 1	Center Name
			Organs - Intestine - Segment 1	Contact First Name
			Organs - Intestine - Segment 1	Contact Last Name
			Organs - Intestine - Segment 1	Contact Email
			Organs - Intestine - Segment 1	Contact Phone Number
			Organs - Intestine - Segment 2	Organ/Vessels Recovered
			Organs - Intestine - Segment 2	Intestine - Segment 2
			Organs - Intestine - Segment 2	Organ Disposition
			Organs - Intestine - Segment 2	Associated Vessels Disposition
			Organs - Intestine - Segment 2	Contacted by OPO?
			Organs - Intestine - Segment 2	Date Contacted
			Organs - Intestine - Segment 2	Center Name
			Organs - Intestine - Segment 2	Contact First Name
			Organs - Intestine - Segment 2	Contact Last Name
			Organs - Intestine - Segment 2	Contact Email
			Organs - Intestine - Segment 2	Contact Phone Number
			Organs - Pancreas - Whole	Organ/Vessels Recovered
			Organs - Pancreas - Whole	Pancreas - Whole
			Organs - Pancreas - Whole	Organ Disposition
			Organs - Pancreas - Whole	Associated Vessels Disposition
			Organs - Pancreas - Whole	Contacted by OPO?
			Organs - Pancreas - Whole	Date Contacted
			Organs - Pancreas - Whole	Center Name
			Organs - Pancreas - Whole	Contact First Name
			Organs - Pancreas - Whole	Contact Last Name
			Organs - Pancreas - Whole	Contact Email
			Organs - Pancreas - Whole	Contact Phone Number
			Organs - Pancreas - Segment 1	Organ/Vessels Recovered
			Organs - Pancreas - Segment 1	Pancreas - Segment 1
			Organs - Pancreas - Segment 1	Organ Disposition
			Organs - Pancreas - Segment 1	Associated Vessels Disposition
			Organs - Pancreas - Segment 1	Contacted by OPO?
			Organs - Pancreas - Segment 1	Date Contacted
			Organs - Pancreas - Segment 1	Center Name
			Organs - Pancreas - Segment 1	Contact First Name
			Organs - Pancreas - Segment 1	Contact Last Name
			Organs - Pancreas - Segment 1	Contact Email
			Organs - Pancreas - Segment 1	Contact Phone Number
			Organs - Pancreas - Segment 2	Organ/Vessels Recovered
			Organs - Pancreas - Segment 2	Pancreas - Segment 2
			Organs - Pancreas - Segment 2	Organ Disposition
			Organs - Pancreas - Segment 2	Associated Vessels Disposition
			Organs - Pancreas - Segment 2	Contacted by OPO?
			Organs - Pancreas - Segment 2	Date Contacted
			Organs - Pancreas - Segment 2	Center Name
			Organs - Pancreas - Segment 2	Contact First Name
			Organs - Pancreas - Segment 2	Contact Last Name
			Organs - Pancreas - Segment 2	Contact Email
			Organs - Pancreas - Segment 2	Contact Phone Number
			Organs - Pancreas - Islet Cells	Organ/Vessels Recovered
			Organs - Pancreas - Islet Cells	Organ Disposition
			Organs - Pancreas - Islet Cells	Associated Vessels Disposition
			Organs - Pancreas - Islet Cells	Contacted by OPO?
			Organs - Pancreas - Islet Cells	Date Contacted
			Organs - Pancreas - Islet Cells	Center Name
			Organs - Pancreas - Islet Cells	Contact First Name
			Organs - Pancreas - Islet Cells	Contact Last Name
			Organs - Pancreas - Islet Cells	Contact Email
			Organs - Pancreas - Islet Cells	Contact Phone Number
			Organs - Kidney - Right	Organ/Vessels Recovered
			Organs - Kidney - Right	Kidney - Right
			Organs - Kidney - Right	Organ Disposition
			Organs - Kidney - Right	Associated Vessels Disposition
			Organs - Kidney - Right	Contacted by OPO?
			Organs - Kidney - Right	Date Contacted
			Organs - Kidney - Right	Center Name
			Organs - Kidney - Right	Contact First Name
			Organs - Kidney - Right	Contact Last Name
			Organs - Kidney - Right	Contact Email
			Organs - Kidney - Right	Contact Phone Number
			Organs - Kidney - Left	Organ/Vessels Recovered
			Organs - Kidney - Left	Kidney - Left
			Organs - Kidney - Left	Organ Disposition
			Organs - Kidney - Left	Associated Vessels Disposition
			Organs - Kidney - Left	Contacted by OPO?
			Organs - Kidney - Left	Date Contacted
			Organs - Kidney - Left	Center Name
			Organs - Kidney - Left	Contact First Name
			Organs - Kidney - Left	Contact Last Name
			Organs - Kidney - Left	Contact Email
			Organs - Kidney - Left	Contact Phone Number
			Vascular Composite Allograft - VCA - Abdominal Wall	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Abdominal Wall	VCA - Abdominal Wall
			Vascular Composite Allograft - VCA - Abdominal Wall	Organ Disposition
			Vascular Composite Allograft - VCA - Abdominal Wall	Contacted by OPO?
			Vascular Composite Allograft - VCA - Abdominal Wall	Date Contacted
			Vascular Composite Allograft - VCA - Abdominal Wall	Center Name
			Vascular Composite Allograft - VCA - Abdominal Wall	Contact First Name
			Vascular Composite Allograft - VCA - Abdominal Wall	Contact Last Name
			Vascular Composite Allograft - VCA - Abdominal Wall	Contact Email
			Vascular Composite Allograft - VCA - Abdominal Wall	Contact Phone Number
			Vascular Composite Allograft - VCA - Head and Neck	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Head and Neck	VCA - Head and neck
			Vascular Composite Allograft - VCA - Head and Neck	Organ Disposition
			Vascular Composite Allograft - VCA - Head and Neck	Contacted by OPO?
			Vascular Composite Allograft - VCA - Head and Neck	Date Contacted
			Vascular Composite Allograft - VCA - Head and Neck	Center Name
			Vascular Composite Allograft - VCA - Head and Neck	Contact First Name
			Vascular Composite Allograft - VCA - Head and Neck	Contact Last Name
			Vascular Composite Allograft - VCA - Head and Neck	Contact Email
			Vascular Composite Allograft - VCA - Head and Neck	Contact Phone Number
			Vascular Composite Allograft - VCA - Upper Limb	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Upper Limb	VCA - Upper Limb
			Vascular Composite Allograft - VCA - Upper Limb	Organ Disposition
			Vascular Composite Allograft - VCA - Upper Limb	Contacted by OPO?
			Vascular Composite Allograft - VCA - Upper Limb	Date Contacted
			Vascular Composite Allograft - VCA - Upper Limb	Center Name
			Vascular Composite Allograft - VCA - Upper Limb	Contact First Name
			Vascular Composite Allograft - VCA - Upper Limb	Contact Last Name
			Vascular Composite Allograft - VCA - Upper Limb	Contact Email
			Vascular Composite Allograft - VCA - Upper Limb	Contact Phone Number
			Vascular Composite Allograft - VCA - Lower Limb	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Lower Limb	VCA - Lower Limb
			Vascular Composite Allograft - VCA - Lower Limb	Organ Disposition
			Vascular Composite Allograft - VCA - Lower Limb	Contacted by OPO?
			Vascular Composite Allograft - VCA - Lower Limb	Date Contacted
			Vascular Composite Allograft - VCA - Lower Limb	Center Name
			Vascular Composite Allograft - VCA - Lower Limb	Contact First Name
			Vascular Composite Allograft - VCA - Lower Limb	Contact Last Name
			Vascular Composite Allograft - VCA - Lower Limb	Contact Email
			Vascular Composite Allograft - VCA - Lower Limb	Contact Phone Number
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	VCA - Musculoskeletal Composite Graft Segment
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Organ Disposition
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Contacted by OPO?
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Date Contacted
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Center Name
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Contact First Name
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Contact Last Name
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Contact Email
			Vascular Composite Allograft - VCA - Musculoskeletal Composite Graft Segment	Contact Phone Number
			Vascular Composite Allograft - VCA - Spleen	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Spleen	VCA - Spleen
			Vascular Composite Allograft - VCA - Spleen	Organ Disposition
			Vascular Composite Allograft - VCA - Spleen	Contacted by OPO?
			Vascular Composite Allograft - VCA - Spleen	Date Contacted
			Vascular Composite Allograft - VCA - Spleen	Center Name
			Vascular Composite Allograft - VCA - Spleen	Contact First Name
			Vascular Composite Allograft - VCA - Spleen	Contact Last Name
			Vascular Composite Allograft - VCA - Spleen	Contact Email
			Vascular Composite Allograft - VCA - Spleen	Contact Phone Number
			Vascular Composite Allograft - VCA - Glands	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Glands	VCA - Glands
			Vascular Composite Allograft - VCA - Glands	Organ Disposition
			Vascular Composite Allograft - VCA - Glands	Contacted by OPO?
			Vascular Composite Allograft - VCA - Glands	Date Contacted
			Vascular Composite Allograft - VCA - Glands	Center Name
			Vascular Composite Allograft - VCA - Glands	Contact First Name
			Vascular Composite Allograft - VCA - Glands	Contact Last Name
			Vascular Composite Allograft - VCA - Glands	Contact Email
			Vascular Composite Allograft - VCA - Glands	Contact Phone Number
			Vascular Composite Allograft - VCA - Genitourinary Organs	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Genitourinary Organs	VCA - Genitourinary Organs
			Vascular Composite Allograft - VCA - Genitourinary Organs	Organ Disposition
			Vascular Composite Allograft - VCA - Genitourinary Organs	Contacted by OPO?
			Vascular Composite Allograft - VCA - Genitourinary Organs	Date Contacted
			Vascular Composite Allograft - VCA - Genitourinary Organs	Center Name
			Vascular Composite Allograft - VCA - Genitourinary Organs	Contact First Name
			Vascular Composite Allograft - VCA - Genitourinary Organs	Contact Last Name
			Vascular Composite Allograft - VCA - Genitourinary Organs	Contact Email
			Vascular Composite Allograft - VCA - Genitourinary Organs	Contact Phone Number
			Vascular Composite Allograft - VCA - Other	Vascular composite allograft (VCA) recovered?
			Vascular Composite Allograft - VCA - Other	VCA - Other
			Vascular Composite Allograft - VCA - Other	Organ Disposition
			Vascular Composite Allograft - VCA - Other	VCA Other Describe
			Vascular Composite Allograft - VCA - Other	Contacted by OPO?
			Vascular Composite Allograft - VCA - Other	Date Contacted
			Vascular Composite Allograft - VCA - Other	Center Name
			Vascular Composite Allograft - VCA - Other	Contact First Name
			Vascular Composite Allograft - VCA - Other	Contact Last Name
			Vascular Composite Allograft - VCA - Other	Contact Email
			Vascular Composite Allograft - VCA - Other	Contact Phone Number
			Tissues - Blood Vessels - Femoral	Tissues recovered?
			Tissues - Blood Vessels - Femoral	Blood Vessels - Femoral
			Tissues - Blood Vessels - Femoral	Organ Disposition
			Tissues - Blood Vessels - Femoral	Contacted by OPO?
			Tissues - Blood Vessels - Femoral	Date Contacted
			Tissues - Blood Vessels - Femoral	Center Name
			Tissues - Blood Vessels - Femoral	Contact First Name
			Tissues - Blood Vessels - Femoral	Contact Last Name
			Tissues - Blood Vessels - Femoral	Contact Email
			Tissues - Blood Vessels - Femoral	Contact Phone Number
			Tissues - Blood Vessels - Iliac	Tissues recovered?
			Tissues - Blood Vessels - Iliac	Blood Vessels - Iliac
			Tissues - Blood Vessels - Iliac	Organ Disposition
			Tissues - Blood Vessels - Iliac	Contacted by OPO?
			Tissues - Blood Vessels - Iliac	Date Contacted
			Tissues - Blood Vessels - Iliac	Center Name
			Tissues - Blood Vessels - Iliac	Contact First Name
			Tissues - Blood Vessels - Iliac	Contact Last Name
			Tissues - Blood Vessels - Iliac	Contact Email
			Tissues - Blood Vessels - Iliac	Contact Phone Number
			Tissues - Blood Vessels - Other	Tissues recovered?
			Tissues - Blood Vessels - Other	Blood Vessels - Other
			Tissues - Blood Vessels - Other	Organ Disposition
			Tissues - Blood Vessels - Other	Contacted by OPO?
			Tissues - Blood Vessels - Other	Date Contacted
			Tissues - Blood Vessels - Other	Center Name
			Tissues - Blood Vessels - Other	Contact First Name
			Tissues - Blood Vessels - Other	Contact Last Name
			Tissues - Blood Vessels - Other	Contact Email
			Tissues - Blood Vessels - Other	Contact Phone Number
			Tissues - Bone	Tissues recovered?
			Tissues - Bone	Tissues - Bone
			Tissues - Bone	Organ Disposition
			Tissues - Bone	Contacted by OPO?
			Tissues - Bone	Date Contacted
			Tissues - Bone	Center Name
			Tissues - Bone	Contact First Name
			Tissues - Bone	Contact Last Name
			Tissues - Bone	Contact Email
			Tissues - Bone	Contact Phone Number
			Tissues - Fascia	Tissues recovered?
			Tissues - Fascia	Tissues - Fascia
			Tissues - Fascia	Organ Disposition
			Tissues - Fascia	Contacted by OPO?
			Tissues - Fascia	Date Contacted
			Tissues - Fascia	Center Name
			Tissues - Fascia	Contact First Name
			Tissues - Fascia	Contact Last Name
			Tissues - Fascia	Contact Email
			Tissues - Fascia	Contact Phone Number
			Tissues - Skin	Tissues recovered?
			Tissues - Skin	Tissues - Skin
			Tissues - Skin	Organ Disposition
			Tissues - Skin	Contacted by OPO?
			Tissues - Skin	Date Contacted
			Tissues - Skin	Center Name
			Tissues - Skin	Contact First Name
			Tissues - Skin	Contact Last Name
			Tissues - Skin	Contact Email
			Tissues - Skin	Contact Phone Number
			Tissues - Tendons	Tissues recovered?
			Tissues - Tendons	Tissues - Tendons
			Tissues - Tendons	Organ Disposition
			Tissues - Tendons	Contacted by OPO?
			Tissues - Tendons	Date Contacted
			Tissues - Tendons	Center Name
			Tissues - Tendons	Contact First Name
			Tissues - Tendons	Contact Last Name
			Tissues - Tendons	Contact Email
			Tissues - Tendons	Contact Phone Number
			Tissues - Heart Valves	Tissues recovered?
			Tissues - Heart Valves	Tissues - Heart Valves
			Tissues - Heart Valves	Organ Disposition
			Tissues - Heart Valves	Contacted by OPO?
			Tissues - Heart Valves	Date Contacted
			Tissues - Heart Valves	Center Name
			Tissues - Heart Valves	Contact First Name
			Tissues - Heart Valves	Contact Last Name
			Tissues - Heart Valves	Contact Email
			Tissues - Heart Valves	Contact Phone Number
			Tissues - Eyes/Corneas	Tissues recovered?
			Tissues - Eyes/Corneas	Tissues - Eyes/Corneas
			Tissues - Eyes/Corneas	Organ Disposition
			Tissues - Eyes/Corneas	Contacted by OPO?
			Tissues - Eyes/Corneas	Date Contacted
			Tissues - Eyes/Corneas	Center Name
			Tissues - Eyes/Corneas	Contact First Name
			Tissues - Eyes/Corneas	Contact Last Name
			Tissues - Eyes/Corneas	Contact Email
			Tissues - Eyes/Corneas	Contact Phone Number
			Tissues - Tissue Other	Tissues recovered?
			Tissues - Tissue Other	Tissues - Tissue Other
			Tissues - Tissue Other	Organ Disposition
			Tissues - Tissue Other	Tissue Other Describe
			Tissues - Tissue Other	Contacted by OPO?
			Tissues - Tissue Other	Date Contacted
			Tissues - Tissue Other	Center Name
			Tissues - Tissue Other	Contact First Name
			Tissues - Tissue Other	Contact Last Name
			Tissues - Tissue Other	Contact Email
			Tissues - Tissue Other	Contact Phone Number
			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].