Information Collection

Scientific Registry of Transplant Recipients Information Collection Effort for Potential Donors for Living Organ Donation

IC 228713 under ICR 202402-0906-003 · OMB 0906-0034.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Scientific Registry of Transplant Recipients Information Collection Effort for Potential Donors for Living Organ Donation	Form and Instruction
1 Living Donor Registration Form 02152024 - Living Donor Registration Form - SRTR LDC - 021220245007.docx	Form and Instruction
1 Living Donor Registration Form 02152024 - Living Donor Registration Form - SRTR LDC - 021220245007.docx	Form and Instruction
2 Potential Living Donor Follow-Up Form 02152024 - Potential Living Donor Follow-Up Form - SRTR LDC - 021220245007.docx	Form and Instruction
2 Potential Living Donor Follow-Up Form 02152024 - Potential Living Donor Follow-Up Form - SRTR LDC - 021220245007.docx	Form and Instruction
3 Reasons Did Not Donate Form 02152024 - Reasons Did Not Donate Form - SRTR LDC - 021220245007.docx	Form and Instruction
3 Reasons Did Not Donate Form 02152024 - Reasons Did Not Donate Form - SRTR LDC - 021220245007.docx	Form and Instruction
SRTR Privacy Act Statement Draft_Updated 03122024.docx Privacy Act Statement	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Living Donor Registration Form	02152024 - Living Donor Registration Form - SRTR LDC - 021220245007.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Potential Living Donor Follow-Up Form	02152024 - Potential Living Donor Follow-Up Form - SRTR LDC - 021220245007.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Reasons Did Not Donate Form	02152024 - Reasons Did Not Donate Form - SRTR LDC - 021220245007.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Organ Procurement and Transplantation Network (OPTN)/SRTR Data System, 09â15â0055.

FR Citation: 87 FR 46967

Number of Respondents: 786

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	4,242	4,242
Annual IC Time Burden (Hours)	1,251	1,251
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Privacy Act Statement	SRTR Privacy Act Statement Draft_Updated 03122024.docx	03/12/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.