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

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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Scientific Registry of Transplant Recipients Information Collection Effort for Potential Donors for Living Organ Donation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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, 09–15–0055.	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 %

	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

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.