OPTN Certificate of Assessment and Program Coverage Plan Membership Application

Organ Procurement and Transplantation Network Application Form

OMB: 0915-0184

IC ID: 226689

Information Collection (IC) Details

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OPTN Certificate of Assessment and Program Coverage Plan Membership Application
 
No Removed
 
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 2 Membership_CertificateAssessment_ProgramCoverage Form.docx Membership_CertificateAssessment_ProgramCoverage Form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

2 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 0 0 -2 0 0 2
Annual IC Time Burden (Hours) 0 0 -6 0 0 6
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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