OPTN Membership Application for Intestine Transplant Programs

Organ Procurement and Transplantation Network Application Form

Documents and Forms

Document Name Document Type
Form 10 OPTN Membership Application for Intestine Transplant Programs Form and Instruction
10 OPTN Membership Application for Intestine Transplant Pro OPTN Membership Application for Intesti.docx Form and Instruction
10 OPTN Membership Application for Intestine Transplant Pro OPTN Membership Application for Intesti.docx Form and Instruction
10 B OPTN Membership Application_Surgeon or Physician Log OPTN Membership Application Surgeon or Physician Log.docx Form and Instruction
10 B OPTN Membership Application_Surgeon or Physician Log OPTN Membership Application Surgeon or Physician Log.docx Form and Instruction
10 10_OPTN Membership Application for Intestine Transplant 10_OPTN Membership Application for Intestine Transplant Programs CLEAN 10072024.docx Form and Instruction
10 10_OPTN Membership Application for Intestine Transplant 10_OPTN Membership Application for Intestine Transplant Programs CLEAN 10072024.docx Form and Instruction
10 10_OPTN Membership Application for Intestine Transplant 10_OPTN Membership Application for Intestine Transplant Programs REDLINE 10072024.docx Form and Instruction
10 10_OPTN Membership Application for Intestine Transplant 10_OPTN Membership Application for Intestine Transplant Programs REDLINE 10072024.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Membership Application for Intestine Transplant Programs	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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10	OPTN Membership Application for Intestine Transplant Programs	OPTN Membership Application for Intesti.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10 B	OPTN Membership Application_Surgeon or Physician Log	OPTN Membership Application Surgeon or Physician Log.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10	10_OPTN Membership Application for Intestine Transplant Programs CLEAN 10072024	10_OPTN Membership Application for Intestine Transplant Programs CLEAN 10072024.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10	10_OPTN Membership Application for Intestine Transplant Programs REDLINE 10072024	10_OPTN Membership Application for Intestine Transplant Programs REDLINE 10072024.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	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	4
Annual IC Time Burden (Hours)	44	44
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.