OPTN Membership Application for Pancreas Transplant Programs

Organ Procurement and Transplantation Network Application Form

OMB: 0915-0184

IC ID: 226683

Information Collection (IC) Details

View Information Collection (IC)

OPTN Membership Application for Pancreas Transplant Programs
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 5 OPTN Membership Application for Pancreas Transplant Programs OPTN Membership Application for Pancrea.docx Yes Yes Fillable Fileable
Form and Instruction 5 B OPTN Membership Application_Surgeon or Physician Log OPTN Membership Application Surgeon or Physician Log.docx Yes Yes Fillable Fileable

Health Health Care Services

 

120 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 31 0 -209 0 0 240
Annual IC Time Burden (Hours) 403 0 -317 0 0 720
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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