Deceased Donor Death Referral

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
Deceased Donor Death Referral_Instructions.docx Instruction
Deceased Donor Death Referral_Instructions.docx Instruction
67 Deceased Donor Death Referral Deceased Donor Death Referral.xlsx Form and Instruction
67 Deceased Donor Death Referral Deceased Donor Death Referral.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Deceased Donor Death Referral	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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			Deceased Donor Death Referral_Instructions.docx		Yes	Yes	Fillable Fileable
Form and Instruction	67	Deceased Donor Death Referral	Deceased Donor Death Referral.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: 57	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
Annual Number of Responses for this IC	3,069	3,069
Annual IC Time Burden (Hours)	1,535	1,535
Annual IC Cost Burden (Dollars)	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.