Heart Transplant Recipient Follow Up Post 5 Year

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
Heart Transplant Recipient Follow Up Post 5 Year_Instructions.docx Instruction
Heart Transplant Recipient Follow Up Post 5 Year_Instructions.docx Instruction
Heart Transplant Recipient Follow Up Post 5 Year_Form_redline.xlsx Other-Redline
Heart Transplant Recipient Follow Up Post 5 Year_Form_redline.xlsx Other-Redline
10 Heart Transplant Recipient Follow Up Post 5 Year_Form_Cl Heart Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx Form
10 Heart Transplant Recipient Follow Up Post 5 Year_Form_Cl Heart Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx Form

Information Collection (IC) Details

IC Title:	Heart Transplant Recipient Follow Up Post 5 Year	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Heart Transplant Recipient Follow Up Post 5 Year_Instructions.docx	Yes	Yes	Fillable Fileable
Form	10	Heart Transplant Recipient Follow Up Post 5 Year_Form_Clean.xlsx	Heart Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Yes	Yes	Fillable Fileable
Other-Redline			Heart Transplant Recipient Follow Up Post 5 Year_Form_redline.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: 145	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	24,810	3,254	21,556
Annual IC Time Burden (Hours)	12,405	1,627	10,778
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.