Information Collection

Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)

IC 214127 under ICR 202306-0915-003 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Document Name Document Type
HeartLung Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx Instruction
HeartLung Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx Instruction
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form. HeartLung Transplant Recipient Follow Up 1_5 Year_Form.xlsx Form
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form. HeartLung Transplant Recipient Follow Up 1_5 Year_Form.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			HeartLung Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx		Yes	Yes	Fillable Fileable
Form	21	Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx	HeartLung Transplant Recipient Follow Up 1_5 Year_Form.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act System of Records Notice #09-15-0055	FR Citation: 87 FR 46967

Number of Respondents: 70	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	147	68	79
Annual IC Time Burden (Hours)	162	75	87
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.