Information Collection

OPTN Membership Application for Intestine Transplant Programs

IC 226692 under ICR 202502-0915-003 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-12-10 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
Form 10 OPTN Membership Application for Intestine Transplant Programs OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
Form 10 B OPTN Membership Application_Surgeon or Physician Log OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
Form 10 10_OPTN Membership Application for Intestine Transplant Programs CLEAN 10072024 OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
Form 10 10_OPTN Membership Application for Intestine Transplant Programs REDLINE 10072024 OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
Form 10V (03.25 version OPTN Membership Application Surgeon or Physician Log OPTN Membership Application for Intestine Transplant Programs	Form and Instruction
Form 10I (03.25 version OPTN Membership Application for Intestine Transplant Programs 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
10V (03.25 version OPTN Membership Application Surgeon or Physician Log V_HSB_0915-0184_OPTN Membership Application Surgeon or Physician Log REDLINE.docx	Form and Instruction
10V (03.25 version OPTN Membership Application Surgeon or Physician Log V_HSB_0915-0184_OPTN Membership Application Surgeon or Physician Log REDLINE.docx	Form and Instruction
10I (03.25 version OPTN Membership Application for Intestine Transplant Pro I_HSB_0915-0184_OPTN Membership Application for Intestine Transplant Programs REDLINE.docx	Form and Instruction
10I (03.25 version OPTN Membership Application for Intestine Transplant Pro I_HSB_0915-0184_OPTN Membership Application for Intestine Transplant Programs REDLINE.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10	Yes	Yes	Fillable Fileable
Form and Instruction	10 B	Yes	Yes	Fillable Fileable
Form and Instruction	10	Yes	Yes	Fillable Fileable
Form and Instruction	10	Yes	Yes	Fillable Fileable
Form and Instruction	10V (03.25 version)	Yes	Yes	Fillable Fileable
Form and Instruction	10I (03.25 version)	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

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.

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