Information Collection

HRSA Division of Transplantation (DoT) Concept Testing

IC 254221 under ICR 202206-0990-003 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HRSA Division of Transplantation (DoT) Concept Testing	Form and Instruction
Form 1 Informed Consent: DoT Concept Testing HRSA Division of Transplantation (DoT) Concept Testing	Form and Instruction
04112022 - Attachment 2 - DoT Concept Testing Screener - CLEAN.docx	Instruction
04112022 - Attachment 2 - DoT Concept Testing Screener - CLEAN.docx	Instruction
04112022 - Attachment 3 - DoT Concept Testing Online Focus Group Guide - CLEAN.docx	Instruction
04112022 - Attachment 3 - DoT Concept Testing Online Focus Group Guide - CLEAN.docx	Instruction
1 Informed Consent: DoT Concept Testing 04112022 - Attachment 1 - DoT Concept Testing Informed Consent - CLEAN.docx	Form and Instruction
1 Informed Consent: DoT Concept Testing 04112022 - Attachment 1 - DoT Concept Testing Informed Consent - CLEAN.docx	Form and Instruction
Fast Track Memo - Living Donation Materials Testing - OMB.docx Fast Track Memo	IC Document
Fast Track Memo - Living Donation Materials Testing - OMB.docx Fast Track Memo	IC Document

IC Title:

HRSA Division of Transplantation (DoT) Concept Testing

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

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	1	Informed Consent: DoT Concept Testing	04112022 - Attachment 1 - DoT Concept Testing Informed Consent - CLEAN.docx	Yes	Yes	Fillable Fileable
Instruction			04112022 - Attachment 2 - DoT Concept Testing Screener - CLEAN.docx	Yes	Yes	Fillable Fileable
Instruction			04112022 - Attachment 3 - DoT Concept Testing Online Focus Group Guide - CLEAN.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Memo	Fast Track Memo - Living Donation Materials Testing - OMB.docx	06/14/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.