OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Organ Procurement and Transplantation Network Application Form

ICR 202502-0915-003 · OMB 0915-0184 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 23 Kidney Paired Donation Pilot Program (KPDPP) contact update Form Form and Instruction Modified Repair queued
Form 23 Kidney Paired Donation Pilot Program (KPDPP) contact update Form Form and Instruction Modified Repair queued
Form 21 HOPE Act Variance Request Form Form and Instruction Modified Available
Form 21 HOPE Act Variance Request Form Form and Instruction Modified Repair queued
Form 20 Additional Surgeon and Physician Request Form Form and Instruction Modified Repair queued
Form 20 Additional Surgeon and Physician Request Form Form and Instruction Modified Repair queued
Form 19 Primary Data Coordinator Form Form and Instruction Modified Available
Form 19 Primary Data Coordinator Form Form and Instruction Modified Repair queued
Form 18 Primary Program Administrator Form Form and Instruction Modified Available
Form 18 Primary Program Administrator Form Form and Instruction Modified Repair queued
Form 17 OPTN Individual Membership Application Form and Instruction Modified Repair queued
Form 17 OPTN Individual Membership Application Form and Instruction Modified Repair queued
Form 16 OPTN Business Membership Application Form and Instruction Modified Available
Form 16 OPTN Business Membership Application Form and Instruction Modified Repair queued
Form 15 OPTN Public Organization Membership Application Form and Instruction Modified Available
Form 15 OPTN Public Organization Membership Application Form and Instruction Modified Repair queued
Form 14 OPTN Medical Scientific Membership Application Form and Instruction Modified Available
Form 14 OPTN Medical Scientific Membership Application Form and Instruction Modified Repair queued
Form 13 OPTN Representative Form Form and Instruction Modified Available
Form 13 OPTN Representative Form Form and Instruction Modified Missing upstream
Form 12 OPTN Membership Application for Histocompatibility Labs Form and Instruction Modified Repair queued
Form 12 OPTN Membership Application for Histocompatibility Labs Form and Instruction Modified Repair queued
Form 11 OPTN Membership Application for OPOs Form and Instruction Modified Repair queued
Form 11 OPTN Membership Application for OPOs Form and Instruction Modified Missing upstream
Form 10 OPTN Membership Application for Intestine Transplant Programs Form and Instruction Modified Repair queued
Form 10 OPTN Membership Application for Intestine Transplant Programs Form and Instruction Modified Repair queued
Form 9 OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application Form and Instruction Modified Repair queued
Form 9 OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application Form and Instruction Modified Repair queued
Form 8 OPTN Membership Application Islet Transplant Program Form and Instruction Modified Available
Form 8 OPTN Membership Application Islet Transplant Program Form and Instruction Modified Missing upstream
Form 7 B OPTN Membership Application for Lung Transplant Program Form and Instruction Modified Repair queued
Form 7 B OPTN Membership Application for Lung Transplant Program Form and Instruction Modified Repair queued
Form 6 B OPTN Membership Application for Heart Transplant Program Form and Instruction Modified Repair queued
Form 6 B OPTN Membership Application for Heart Transplant Program Form and Instruction Modified Repair queued
Form 5 B OPTN Membership Application for Pancreas Transplant Programs Form and Instruction Modified Available
Form 5 B OPTN Membership Application for Pancreas Transplant Programs Form and Instruction Modified Repair queued
Form 4 B OPTN Membership Application for Liver Transplant Progrms Form and Instruction Modified Repair queued
Form 4 B OPTN Membership Application for Liver Transplant Progrms Form and Instruction Modified Repair queued
Form 3 B OPTN Membership Application for Kidney Transplant Programs Form and Instruction Modified Repair queued
Form 3 B OPTN Membership Application for Kidney Transplant Programs Form and Instruction Modified Repair queued
Form 1 OPTN Membership Application for Transplant Hospitals and Programs Form and Instruction Modified Repair queued
Form 1 OPTN Membership Application for Transplant Hospitals and Programs Form and Instruction Modified Repair queued
HSB_0915-0184_OMB NonSubstantive Change Request.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-26 Available
HSB_0915-0184_OMB NonSubstantive Change Request.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-26 Repair queued
10072024 - Membership Non-Substantive Change Memo Updated - CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-10-07 Repair queued
10072024 - Membership Non-Substantive Change Memo Updated - CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-10-07 Repair queued
10062023 - Change Memo - 091820235005 - CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-10-13 Repair queued
10062023 - Change Memo - 091820235005 - CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-10-13 Repair queued
10252022 - Supporting Statement - OMB 0915-0184.docx Supporting Statement A Uploaded 2022-11-18 Available
10252022 - Supporting Statement - OMB 0915-0184.docx Supporting Statement A Uploaded 2022-11-18 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
257000 Kidney Paired Donation Pilot Program (KPDPP) contact update Form Form and Instruction Modified
257000 Kidney Paired Donation Pilot Program (KPDPP) contact update Form Form and Instruction Modified
256999 HOPE Act Variance Request Form Form and Instruction Modified
256999 HOPE Act Variance Request Form Form and Instruction Modified
256998 Additional Surgeon and Physician Request Form Form and Instruction Modified
256998 Additional Surgeon and Physician Request Form Form and Instruction Modified
256997 Primary Data Coordinator Form Form and Instruction Modified
256997 Primary Data Coordinator Form Form and Instruction Modified
256996 Primary Program Administrator Form Form and Instruction Modified
256996 Primary Program Administrator Form Form and Instruction Modified
226701 OPTN Individual Membership Application Form and Instruction Modified
226701 OPTN Individual Membership Application Form and Instruction Modified
226700 OPTN Business Membership Application Form and Instruction Modified
226700 OPTN Business Membership Application Form and Instruction Modified
226699 OPTN Public Organization Membership Application Form and Instruction Modified
226699 OPTN Public Organization Membership Application Form and Instruction Modified
226698 OPTN Medical Scientific Membership Application Form and Instruction Modified
226698 OPTN Medical Scientific Membership Application Form and Instruction Modified
226695 OPTN Representative Form Form and Instruction Modified
226695 OPTN Representative Form Form and Instruction Modified
226694 OPTN Membership Application for Histocompatibility Labs Form and Instruction Modified
226694 OPTN Membership Application for Histocompatibility Labs Form and Instruction Modified
226693 OPTN Membership Application for OPOs Form and Instruction Modified
226693 OPTN Membership Application for OPOs Form and Instruction Modified
226692 OPTN Membership Application for Intestine Transplant Programs Form and Instruction Modified
226692 OPTN Membership Application for Intestine Transplant Programs Form and Instruction Modified
226687 OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application Form and Instruction Modified
226687 OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application Form and Instruction Modified
226686 OPTN Membership Application Islet Transplant Program Form and Instruction Modified
226686 OPTN Membership Application Islet Transplant Program Form and Instruction Modified
226685 OPTN Membership Application for Lung Transplant Program Form and Instruction Modified
226685 OPTN Membership Application for Lung Transplant Program Form and Instruction Modified
226684 OPTN Membership Application for Heart Transplant Program Form and Instruction Modified
226684 OPTN Membership Application for Heart Transplant Program Form and Instruction Modified
226683 OPTN Membership Application for Pancreas Transplant Programs Form and Instruction Modified
226683 OPTN Membership Application for Pancreas Transplant Programs Form and Instruction Modified
226682 OPTN Membership Application for Liver Transplant Progrms Form and Instruction Modified
226682 OPTN Membership Application for Liver Transplant Progrms Form and Instruction Modified
226681 OPTN Membership Application for Kidney Transplant Programs Form and Instruction Modified
226681 OPTN Membership Application for Kidney Transplant Programs Form and Instruction Modified
226680 OPTN Membership Application for Transplant Hospitals and Programs Form and Instruction Modified
226680 OPTN Membership Application for Transplant Hospitals and Programs Form and Instruction Modified
ICR Details
StatusActive
Agency/SubagencyHHS/HSA
OMB Control No0915-0184
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202410-0915-001
Agency Tracking No21566
Date Submitted to OIRA2025-03-28
Requested Expiration Date1969-12-31