Data System for Organ Procurement and Transplantation Network

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Deceased Donor Registration_Form_Clean.xlsx	Form	Modified	Available
Form 70 Transplant Center Contact Management	Form and Instruction	New	Available
Form 69 Donor Organ Disposition	Form	New	Repair queued
Form 68 Donor Hospital Registration	Form	New	Repair queued
Form 67 Deceased Donor Death Referral	Form and Instruction	New	Available
Form 66 Death Notification Registration	Form	New	Available
Form 65 Potential Transplant Recipient	Form	New	Available
Form 64 OPO Notification Limit Administration	Form	New	Available
Form 63 Initial Donor Registration	Form	New	Repair queued
Form 62 Request to Unlock Form_Form.xlsx	Form	Modified	Available
Form 61 Potential Disease Transmission Report_Form.xlsx	Form	Modified	Available
Form 60 Safety Situation_Form.xlsx	Form	Modified	Available
Form 59 Living Donor Event_Form.xlsx	Form	Modified	Available
Form 58 Disease Transmission Event_Form.xlsx	Form	Modified	Available
Form 57 Kidney Paired Donation Match Offer Management_Form.xlsx	Form	Modified	Available
Form 56 Kidney Paired Donation Donor Registration_Form_clean.xlsx	Form	Modified	Available
Form 55 Kidney Paired Donation Candidate Registration_Form_clean.xlsx	Form	Modified	Available
Form 54 Organ Tracking and Validating_Form.xlsx	Form	Modified	Available
Form 53 Organ Labeling and Packaging_Form.xlsx	Form	Modified	Available
Form 52 VCA Transplant Recipient Follow Up_Form_clean.xlsx	Form	Modified	Available
Form 51 VCA Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 49 Kidney/Pancreas Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 48 Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Form	Modified	Available
Form 47 Kidney/Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Form	Modified	Available
Form 46 Kidney/Pancreas Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 44 Pancreas Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 43 Pancreas Transplant Recipient Follow Up Post 5 Year_ Form_clean.xlsx	Form	Modified	Available
Form 42 Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Form	Modified	Repair queued
Form 41 Pancreas Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 39 Kidney Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 38 Kidney Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Form	Modified	Available
Form 34 Intestine Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 33 Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Form	Modified	Available
Form 29 Liver Post Transplant Malignancy_Form.xlsx	Form	Modified	Repair queued
Form 27 Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Form	Modified	Available
Form 23 HeartLung Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 17 Lung Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 16 Lung Transplant Recipient Follow Up Post 5 Year_Form	Form	Modified	Available
Form 15 Lung Transplant Recipient Follow Up 1_5 Year_Form	Form	Modified	Available
Form 14 Lung Transplant Recipient Follow Up 6 Month_Form.xlsx	Form	Modified	Available
Form 13 Lung Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 11 Heart Post Transplant Malignancy_Form.xlsx	Form	Modified	Available
Form 10 Heart Transplant Recipient Follow Up Post 5 Year_Form_Clean.xlsx	Form	Modified	Available
Form 9 Heart Transplant Recipient Follow Up 1_5 Year _Form_Clean.xlsx	Form	Modified	Available
Form 8 Heart Transplant Recipient Follow Up 6 Month_Form.xlsx	Form	Modified	Available
Form 7 Heart Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 50 VCA Transplant Candidate Registration_Form.xlsx	Form	Modified	Available
Form 28 Liver Explant Pathology Form.xlsx	Form	Modified	Available
Form 22 Heart/Lung Transplant Recipient Follow Up Post 5 Year_Form.xlsx	Form	Modified	Available
Form 21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx	Form	Modified	Available
Form 20 Heart/Lung Transplant Recipient Follow Up 6 Month_Form.xlsx	Form	Modified	Available
Form 19 Heart/Lung Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 32 Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Form	Modified	Available
Form 31 Intestine Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 30 Intestine Transplant Candidate Registration_Form_clean.xlsx	Form	Modified	Available
Form 40 Pancreas Transplant Candidate Registration_Form_clean.xlsx	Form	Modified	Repair queued
Form 45 Kidney/Pancreas Transplant Candidate Registration_Form_clean.xlsx	Form	Modified	Available
Form 26 Liver Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Form	Modified	Available
Form 25 Liver Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Repair queued
Form 24 Liver Transplant Candidate Registration_Form.xlsx	Form	Modified	Repair queued
Form 37 Kidney Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Form	Modified	Available
Form 36 Kidney Transplant Recipient Registration_Form_clean.xlsx	Form	Modified	Available
Form 35 Kidney Transplant Candidate Registration_Form_clean.xlsx	Form	Modified	Repair queued
Form 18 Heart/Lung Transplant Candidate Registration_Form_clean.xlsx	Form	Modified	Repair queued
Form 12 Lung Transplant Candidate Registration_Form	Form	Modified	Available
Form 6 Heart Transplant Candidate Registration_Form_clean.xlsx	Form	Modified	Available
Form 5 Recipient Histocompatibility_Form._Clean.xlsx	Form	Modified	Available
Form 4 Donor Histocompatibility_Form_Clean.xlsx	Form	Modified	Available
Form 3 Living Donor Follow Up_Form_Clean.xlsx	Form	Modified	Available
Form 2 Living Donor Registration_Form_clean	Form	Modified	Available
05192023 - Supporting Statement - 30 day FRN 0915 0157 - Revision - 040620235002.docx	Supporting Statement A	Uploaded 2023-06-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6389	Deceased Donor Registration (DDR)	Form	Modified	Deceased Donor Registration_Form_Clean.xlsx
6389	Deceased Donor Registration (DDR)	Instruction	Modified
260702	Transplant Center Contact Management	Form and Instruction	New	Transplant Center Contact Management
260702	Transplant Center Contact Management	Instruction	New
260701	Donor Organ Disposition	Form	New	Donor Organ Disposition
260701	Donor Organ Disposition	Instruction	New
260700	Donor Hospital Registration	Form	New	Donor Hospital Registration
260700	Donor Hospital Registration	Instruction	New
260699	Deceased Donor Death Referral	Form and Instruction	New	Deceased Donor Death Referral
260699	Deceased Donor Death Referral	Instruction	New
260698	Death Notification Registration	Form	New	Death Notification Registration
260698	Death Notification Registration	Instruction	New
260697	Potential Transplant Recipient	Form	New	Potential Transplant Recipient
260697	Potential Transplant Recipient	Instruction	New
260696	OPO Notification Limit Administration	Form	New	OPO Notification Limit Administration
260696	OPO Notification Limit Administration	Instruction	New
260695	Initial Donor Registration	Form	New	Initial Donor Registration
260695	Initial Donor Registration	Instruction	New
251650	Request to Unlock Form	Form	Modified	Request to Unlock Form_Form.xlsx
251650	Request to Unlock Form	Instruction	Modified
251649	Potential Disease Transmission Report	Form	Modified	Potential Disease Transmission Report_Form.xlsx
251649	Potential Disease Transmission Report	Instruction	Modified
251648	Safety Situation	Form	Modified	Safety Situation_Form.xlsx
251648	Safety Situation	Instruction	Modified
251647	Living Donor Event	Form	Modified	Living Donor Event_Form.xlsx
251647	Living Donor Event	Instruction	Modified
251645	Disease Transmission Event	Form	Modified	Disease Transmission Event_Form.xlsx
251645	Disease Transmission Event	Instruction	Modified
251644	Kidney Paired Donation Match Offer Management	Form	Modified	Kidney Paired Donation Match Offer Management_Form.xlsx
251644	Kidney Paired Donation Match Offer Management	Instruction	Modified
251643	Kidney Paired Donation Donor Registration	Form	Modified	Kidney Paired Donation Donor Registration_Form_clean.xlsx
251643	Kidney Paired Donation Donor Registration	Instruction	Modified
251642	Kidney Paired Donation Candidate Registration	Form	Modified	Kidney Paired Donation Candidate Registration_Form_clean.xlsx
251642	Kidney Paired Donation Candidate Registration	Instruction	Modified
251641	Organ Tracking and Validating System	Form	Modified	Organ Tracking and Validating_Form.xlsx
251641	Organ Tracking and Validating System	Instruction	Modified
251640	Organ Labeling and Packaging System	Form	Modified	Organ Labeling and Packaging_Form.xlsx
251640	Organ Labeling and Packaging System	Instruction	Modified
226455	VCA Transplant Recipient Follow Up (TRF)	Form	Modified	VCA Transplant Recipient Follow Up_Form_clean.xlsx
226455	VCA Transplant Recipient Follow Up (TRF)	Instruction	Modified
226454	VCA Transplant Recipient Registration (TRR)	Form	Modified	VCA Transplant Recipient Registration_Form_clean.xlsx
226454	VCA Transplant Recipient Registration (TRR)	Instruction	Modified
226453	Kidney/Pancreas Post Transplant Malignancy (PTM) Form	Form	Modified	Kidney/Pancreas Post Transplant Malignancy_Form.xlsx
226453	Kidney/Pancreas Post Transplant Malignancy (PTM) Form	Instruction	Modified
226452	Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
226452	Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
226451	Kidney/Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Form	Modified	Kidney/Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
226451	Kidney/Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Instruction	Modified
226449	Kidney/Pancreas Transplant Recipient Registration (TRR)	Form	Modified	Kidney/Pancreas Transplant Recipient Registration_Form_clean.xlsx
226449	Kidney/Pancreas Transplant Recipient Registration (TRR)	Instruction	Modified
226448	Pancreas Post Transplant Malignancy (PTM) Form	Form	Modified	Pancreas Post Transplant Malignancy_Form.xlsx
226448	Pancreas Post Transplant Malignancy (PTM) Form	Instruction	Modified
226447	Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Pancreas Transplant Recipient Follow Up Post 5 Year_ Form_clean.xlsx
226447	Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
226446	Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Form	Modified	Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
226446	Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Instruction	Modified
226445	Pancreas Transplant Recipient Registration (TRR)	Form	Modified	Pancreas Transplant Recipient Registration_Form_clean.xlsx
226445	Pancreas Transplant Recipient Registration (TRR)	Instruction	Modified
226443	Kidney Post Transplant Malignancy (PTM) Form	Form	Modified	Kidney Post Transplant Malignancy_Form.xlsx
226443	Kidney Post Transplant Malignancy (PTM) Form	Instruction	Modified
226442	Kidney Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Kidney Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
226442	Kidney Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
226441	Intestine Post Transplant Malignancy (PTM) Form	Form	Modified	Intestine Post Transplant Malignancy_Form.xlsx
226441	Intestine Post Transplant Malignancy (PTM) Form	Instruction	Modified
226440	Intestine Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
226440	Intestine Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
226439	Liver Post Transplant Malignancy (PTM) Form	Form	Modified	Liver Post Transplant Malignancy_Form.xlsx
226439	Liver Post Transplant Malignancy (PTM) Form	Instruction	Modified
226438	Liver Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
226438	Liver Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
226431	Heart/Lung Post Transplant Malignancy (PTM) Form	Form	Modified	HeartLung Post Transplant Malignancy_Form.xlsx
226431	Heart/Lung Post Transplant Malignancy (PTM) Form	Instruction	Modified
226430	Lung - Post Transplant Malignancy (PTM) Form	Form	Modified	Lung Post Transplant Malignancy_Form.xlsx
226430	Lung - Post Transplant Malignancy (PTM) Form	Instruction	Modified
226428	Lung Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Lung Transplant Recipient Follow Up Post 5 Year_Form
226428	Lung Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
226426	Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Form	Modified	Lung Transplant Recipient Follow Up 1_5 Year_Form
226426	Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Instruction	Modified
226425	Lung Transplant Recipient Follow Up 6 Month (TRF)	Form	Modified	Lung Transplant Recipient Follow Up 6 Month_Form.xlsx
226425	Lung Transplant Recipient Follow Up 6 Month (TRF)	Instruction	Modified
226424	Lung Transplant Recipient Registration (TRR)	Form	Modified	Lung Transplant Recipient Registration_Form_clean.xlsx
226424	Lung Transplant Recipient Registration (TRR)	Instruction	Modified
226422	Heart Post-Transplant Malignancy Form	Form	Modified	Heart Post Transplant Malignancy_Form.xlsx
226422	Heart Post-Transplant Malignancy Form	Instruction	Modified
226418	Heart Transplant Recipient Follow Up Post 5 Year	Form	Modified	Heart Transplant Recipient Follow Up Post 5 Year_Form_Clean.xlsx
226418	Heart Transplant Recipient Follow Up Post 5 Year	Instruction	Modified
226417	Heart Transplant Recipient Follow Up 1-5 Year	Form	Modified	Heart Transplant Recipient Follow Up 1_5 Year _Form_Clean.xlsx
226417	Heart Transplant Recipient Follow Up 1-5 Year	Instruction	Modified
226416	Heart Follow Up (6 months)	Form	Modified	Heart Transplant Recipient Follow Up 6 Month_Form.xlsx
226416	Heart Follow Up (6 months)	Instruction	Modified
226415	Heart Recepient Registration	Form	Modified	Heart Transplant Recipient Registration_Form_clean.xlsx
226415	Heart Recepient Registration	Instruction	Modified
214131	VCA Transplant Candidate Registration (TCR)	Form	Modified	VCA Transplant Candidate Registration_Form.xlsx
214131	VCA Transplant Candidate Registration (TCR)	Instruction	Modified
214130	Liver Recipient Explant Pathology Form	Form	Modified	Liver Explant Pathology Form.xlsx
214130	Liver Recipient Explant Pathology Form	Instruction	Modified
214128	Heart/Lung Transplant Recipient Follow Up Post 5 Year (TRF)	Form	Modified	Heart/Lung Transplant Recipient Follow Up Post 5 Year_Form.xlsx
214128	Heart/Lung Transplant Recipient Follow Up Post 5 Year (TRF)	Instruction	Modified
214127	Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Form	Modified	Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
214127	Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Instruction	Modified
214126	Heart/Lung Transplant Recipient Follow Up 6 Month (TRF)	Form	Modified	Heart/Lung Transplant Recipient Follow Up 6 Month_Form.xlsx
214126	Heart/Lung Transplant Recipient Follow Up 6 Month (TRF)	Instruction	Modified
214124	Heart/Lung Recipient Registration	Form	Modified	Heart/Lung Transplant Recipient Registration_Form_clean.xlsx
214124	Heart/Lung Recipient Registration	Instruction	Modified
181750	Intestine Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Form	Modified	Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
181750	Intestine Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Instruction	Modified
181749	Intestine Transplant Recipient Registration (TRR)	Form	Modified	Intestine Transplant Recipient Registration_Form_clean.xlsx
181749	Intestine Transplant Recipient Registration (TRR)	Instruction	Modified
181748	Intestine Transplant Candidate Registration (TCR)	Form	Modified	Intestine Transplant Candidate Registration_Form_clean.xlsx
181748	Intestine Transplant Candidate Registration (TCR)	Instruction	Modified
181745	Pancreas Transplant Candidate Registration (TCR)	Form	Modified	Pancreas Transplant Candidate Registration_Form_clean.xlsx
181745	Pancreas Transplant Candidate Registration (TCR)	Instruction	Modified
181742	Kidney/Pancreas Transplant Candidate Registration (TCR)	Form	Modified	Kidney/Pancreas Transplant Candidate Registration_Form_clean.xlsx
181742	Kidney/Pancreas Transplant Candidate Registration (TCR)	Instruction	Modified
181741	Liver Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Form	Modified	Liver Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
181741	Liver Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Instruction	Modified
181740	Liver Transplant Recipient Registration (TRR)	Form	Modified	Liver Transplant Recipient Registration_Form_clean.xlsx
181740	Liver Transplant Recipient Registration (TRR)	Instruction	Modified
181739	Liver Transplant Candidate Registration (TCR)	Form	Modified	Liver Transplant Candidate Registration_Form.xlsx
181739	Liver Transplant Candidate Registration (TCR)	Instruction	Modified
181738	Kidney Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Form	Modified	Kidney Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
181738	Kidney Transplant Recipient Follow Up 6 Month -5 Year (TRF)	Instruction	Modified
181737	Kidney Transplant Recipient Registration (TRR)	Form	Modified	Kidney Transplant Recipient Registration_Form_clean.xlsx
181737	Kidney Transplant Recipient Registration (TRR)	Instruction	Modified
181736	Kidney Transplant Candidate Registration (TCR)	Form	Modified	Kidney Transplant Candidate Registration_Form_clean.xlsx
181736	Kidney Transplant Candidate Registration (TCR)	Instruction	Modified
181733	Heart/Lung Transplant Candidate Registration (TCR)	Form	Modified	Heart/Lung Transplant Candidate Registration_Form_clean.xlsx
181733	Heart/Lung Transplant Candidate Registration (TCR)	Instruction	Modified
181732	Lung Transplant Candidate Registration (TCR)	Form	Modified	Lung Transplant Candidate Registration_Form
181732	Lung Transplant Candidate Registration (TCR)	Instruction	Modified
181731	Heart Transplant Candidate Registration (TCR)	Form	Modified	Heart Transplant Candidate Registration_Form_clean.xlsx
181731	Heart Transplant Candidate Registration (TCR)	Instruction	Modified
181730	Recipient Histocompatibility Form	Form	Modified	Recipient Histocompatibility_Form._Clean.xlsx
181730	Recipient Histocompatibility Form	Instruction	Modified
181729	Donor Histocompatibility Form	Form	Modified	Donor Histocompatibility_Form_Clean.xlsx
181729	Donor Histocompatibility Form	Instruction	Modified
181728	Living Donor Follow-up (LDF)	Form	Modified	Living Donor Follow Up_Form_Clean.xlsx
181728	Living Donor Follow-up (LDF)	Instruction	Modified
181727	Living Donor Registration (LDR)	Form	Modified	Living Donor Registration_Form_clean
181727	Living Donor Registration (LDR)	Instruction	Modified

ICR Details

OMB Control No: 0915-0157	ICR Reference No: 202306-0915-003
Status: Historical Active	Previous ICR Reference No: 202202-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Data System for Organ Procurement and Transplantation Network
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/13/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/27/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved	03/31/2025
Responses	2,352,737	0	604,519
Time Burden (Hours)	647,633	0	430,267
Cost Burden (Dollars)	0	0	0

---

Abstract: These forms, which collect data on donors and potential transplant recipients, and the information gathered from the forms, are needed to enable the OPTN to operate a computerized matching system to facilitate matching organs from donors to those who are in need of organs based on medical criteria. In addition, the OPTN shares this data with the Scientific Registry of Transplant Recipients (SRTR) to enable the SRTR to provide statistical and analytic support for the OPTN Board of Directors and committees, HRSA, and the Department of Health and Human Services (HHS) Advisory Committee on Organ Transplantation (ACOT). Respondents include transplant hospitals, organ procurement organizations, and histocompatibility laboratories.

---

Authorizing Statute(s): US Code: 42 USC 274(b)(2)(I), Sec 372(b)(2)(I) Name of Law: PHS Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 59103	09/29/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 38873	06/14/2023
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 70

table that charts list of burden

IC Title	Form No.	Form Name
Death Notification Registration	66	Death Notification Registration
Deceased Donor Death Referral	67	Deceased Donor Death Referral
Deceased Donor Registration (DDR)	1	Deceased Donor Registration_Form_Clean.xlsx
Disease Transmission Event	58	Disease Transmission Event_Form.xlsx
Donor Histocompatibility Form	4	Donor Histocompatibility_Form_Clean.xlsx
Donor Hospital Registration	68	Donor Hospital Registration
Donor Organ Disposition	69	Donor Organ Disposition
Heart Follow Up (6 months)	8	Heart Transplant Recipient Follow Up 6 Month_Form.xlsx
Heart Post-Transplant Malignancy Form	11	Heart Post Transplant Malignancy_Form.xlsx
Heart Recepient Registration	7	Heart Transplant Recipient Registration_Form_clean.xlsx
Heart Transplant Candidate Registration (TCR)	6	Heart Transplant Candidate Registration_Form_clean.xlsx
Heart Transplant Recipient Follow Up 1-5 Year	9	Heart Transplant Recipient Follow Up 1_5 Year _Form_Clean.xlsx
Heart Transplant Recipient Follow Up Post 5 Year	10	Heart Transplant Recipient Follow Up Post 5 Year_Form_Clean.xlsx
Heart/Lung Post Transplant Malignancy (PTM) Form	23	HeartLung Post Transplant Malignancy_Form.xlsx
Heart/Lung Recipient Registration	19	Heart/Lung Transplant Recipient Registration_Form_clean.xlsx
Heart/Lung Transplant Candidate Registration (TCR)	18	Heart/Lung Transplant Candidate Registration_Form_clean.xlsx
Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)	21	Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
Heart/Lung Transplant Recipient Follow Up 6 Month (TRF)	20	Heart/Lung Transplant Recipient Follow Up 6 Month_Form.xlsx
Heart/Lung Transplant Recipient Follow Up Post 5 Year (TRF)	22	Heart/Lung Transplant Recipient Follow Up Post 5 Year_Form.xlsx
Initial Donor Registration	63	Initial Donor Registration
Intestine Post Transplant Malignancy (PTM) Form	34	Intestine Post Transplant Malignancy_Form.xlsx
Intestine Transplant Candidate Registration (TCR)	30	Intestine Transplant Candidate Registration_Form_clean.xlsx
Intestine Transplant Recipient Follow Up 6 Month -5 Year (TRF)	32	Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Intestine Transplant Recipient Follow Up Post 5 Year (TRF)	33	Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Intestine Transplant Recipient Registration (TRR)	31	Intestine Transplant Recipient Registration_Form_clean.xlsx
Kidney Paired Donation Candidate Registration	55	Kidney Paired Donation Candidate Registration_Form_clean.xlsx
Kidney Paired Donation Donor Registration	56	Kidney Paired Donation Donor Registration_Form_clean.xlsx
Kidney Paired Donation Match Offer Management	57	Kidney Paired Donation Match Offer Management_Form.xlsx
Kidney Post Transplant Malignancy (PTM) Form	39	Kidney Post Transplant Malignancy_Form.xlsx
Kidney Transplant Candidate Registration (TCR)	35	Kidney Transplant Candidate Registration_Form_clean.xlsx
Kidney Transplant Recipient Follow Up 6 Month -5 Year (TRF)	37	Kidney Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Kidney Transplant Recipient Follow Up Post 5 Year (TRF)	38	Kidney Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Kidney Transplant Recipient Registration (TRR)	36	Kidney Transplant Recipient Registration_Form_clean.xlsx
Kidney/Pancreas Post Transplant Malignancy (PTM) Form	49	Kidney/Pancreas Post Transplant Malignancy_Form.xlsx
Kidney/Pancreas Transplant Candidate Registration (TCR)	45	Kidney/Pancreas Transplant Candidate Registration_Form_clean.xlsx
Kidney/Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)	47	Kidney/Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)	48	Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Kidney/Pancreas Transplant Recipient Registration (TRR)	46	Kidney/Pancreas Transplant Recipient Registration_Form_clean.xlsx
Liver Post Transplant Malignancy (PTM) Form	29	Liver Post Transplant Malignancy_Form.xlsx
Liver Recipient Explant Pathology Form	28	Liver Explant Pathology Form.xlsx
Liver Transplant Candidate Registration (TCR)	24	Liver Transplant Candidate Registration_Form.xlsx
Liver Transplant Recipient Follow Up 6 Month -5 Year (TRF)	26	Liver Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Liver Transplant Recipient Follow Up Post 5 Year (TRF)	27	Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Liver Transplant Recipient Registration (TRR)	25	Liver Transplant Recipient Registration_Form_clean.xlsx
Living Donor Event	59	Living Donor Event_Form.xlsx
Living Donor Follow-up (LDF)	3	Living Donor Follow Up_Form_Clean.xlsx
Living Donor Registration (LDR)	2	Living Donor Registration_Form_clean
Lung - Post Transplant Malignancy (PTM) Form	17	Lung Post Transplant Malignancy_Form.xlsx
Lung Transplant Candidate Registration (TCR)	12	Lung Transplant Candidate Registration_Form
Lung Transplant Recipient Follow Up 1-5 Year (TRF)	15	Lung Transplant Recipient Follow Up 1_5 Year_Form
Lung Transplant Recipient Follow Up 6 Month (TRF)	14	Lung Transplant Recipient Follow Up 6 Month_Form.xlsx
Lung Transplant Recipient Follow Up Post 5 Year (TRF)	16	Lung Transplant Recipient Follow Up Post 5 Year_Form
Lung Transplant Recipient Registration (TRR)	13	Lung Transplant Recipient Registration_Form_clean.xlsx
OPO Notification Limit Administration	64	OPO Notification Limit Administration
Organ Labeling and Packaging System	53	Organ Labeling and Packaging_Form.xlsx
Organ Tracking and Validating System	54	Organ Tracking and Validating_Form.xlsx
Pancreas Post Transplant Malignancy (PTM) Form	44	Pancreas Post Transplant Malignancy_Form.xlsx
Pancreas Transplant Candidate Registration (TCR)	40	Pancreas Transplant Candidate Registration_Form_clean.xlsx
Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)	42	Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)	43	Pancreas Transplant Recipient Follow Up Post 5 Year_ Form_clean.xlsx
Pancreas Transplant Recipient Registration (TRR)	41	Pancreas Transplant Recipient Registration_Form_clean.xlsx
Potential Disease Transmission Report	61	Potential Disease Transmission Report_Form.xlsx
Potential Transplant Recipient	65	Potential Transplant Recipient
Recipient Histocompatibility Form	5	Recipient Histocompatibility_Form._Clean.xlsx
Request to Unlock Form	62	Request to Unlock Form_Form.xlsx
Safety Situation	60	Safety Situation_Form.xlsx
Transplant Center Contact Management	70	Transplant Center Contact Management
VCA Transplant Candidate Registration (TCR)	50	VCA Transplant Candidate Registration_Form.xlsx
VCA Transplant Recipient Follow Up (TRF)	52	VCA Transplant Recipient Follow Up_Form_clean.xlsx
VCA Transplant Recipient Registration (TRR)	51	VCA Transplant Recipient Registration_Form_clean.xlsx

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,352,737	604,519	0	1,748,218	0	0
Annual Time Burden (Hours)	647,633	430,267	0	217,366	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The increase in burden hours is mostly due to the addition of eight collection forms from the OPTN donor management and organ matching system to this data collection package. Burden hours for each form are updated based off of annual data, which is the reason for burden increases in some forms and decreases in others.

---

Annual Cost to Federal Government: $600,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/27/2023

---