Information Collection

Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)

IC 214127 under ICR 202202-0915-002 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Form
Heart Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx	Instruction
Heart Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx	Instruction
HeartLung Transplant Recipient Follow Up 1_5 Year_Form_redline.xlsx	Other-Redline
HeartLung Transplant Recipient Follow Up 1_5 Year_Form_redline.xlsx	Other-Redline
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form_ HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	Form
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form_ HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	Form

IC Title:

Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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
Instruction			Heart Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx	Yes	Yes	Fillable Fileable
Form	21	Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	Yes	Yes	Fillable Fileable
Other-Redline			HeartLung Transplant Recipient Follow Up 1_5 Year_Form_redline.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 69

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	79	79
Annual IC Time Burden (Hours)	87	87
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.