Information Collection

OPTN Membership Application for Heart Transplant Program

IC 226684 under ICR 202310-0915-002 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 B OPTN Membership Application for Heart Transplant Program	Form and Instruction
6 B OPTN Membership Application_Surgeon or Physician Log OPTN Membership Application Surgeon or Physician Log.docx	Form and Instruction
6 B OPTN Membership Application_Surgeon or Physician Log OPTN Membership Application Surgeon or Physician Log.docx	Form and Instruction
6 OPTN Membership Application for Heart Transplant Program 09182023 - 06_OPTN Membership Application for Heart Transplant Programs - REDLINE.docx	Form and Instruction
6 OPTN Membership Application for Heart Transplant Program 09182023 - 06_OPTN Membership Application for Heart Transplant Programs - REDLINE.docx	Form and Instruction

IC Title:

OPTN Membership Application for Heart Transplant Program

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6 B	OPTN Membership Application_Surgeon or Physician Log	OPTN Membership Application Surgeon or Physician Log.docx		Yes	Yes	Fillable Fileable
Form and Instruction	6	OPTN Membership Application for Heart Transplant Programs	09182023 - 06_OPTN Membership Application for Heart Transplant Programs - REDLINE.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	49	49
Annual IC Time Burden (Hours)	1,005	1,005
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.