OPTN Membership Application for Histocompatibility Labs

Organ Procurement and Transplantation Network Application Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Document Name Document Type
Form 12 OPTN Membership Application for Histocompatibility Labs Form and Instruction
12 OPTN Membership Application for Histocompatibility Labor OPTN Membership Application for Histoco.docx Form and Instruction
12 OPTN Membership Application for Histocompatibility Labor OPTN Membership Application for Histoco.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Membership Application for Histocompatibility Labs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	12	OPTN Membership Application for Histocompatibility Laboratories	OPTN Membership Application for Histoco.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 141	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	-24	54
Annual IC Time Burden (Hours)	75	-87	162
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.