Information Collection

Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)

IC 214127 under ICR 202506-0915-004 · OMB 0915-0157.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)	Form
21. HeartLung Transplant Recipient Follow Up 1_5 Year_Instructions.docx	Instruction
21. HeartLung Transplant Recipient Follow Up 1_5 Year_Instructions.docx	Instruction
21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_redline.xlsx	Other-Redline
21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_redline.xlsx	Other-Redline
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form. 21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	Form
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form. 21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Form	21	Yes	Yes	Fillable Fileable
Other-Redline		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act System of Records Notice #09-15-0055

FR Citation: 87 FR 46967

Number of Respondents: 72

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	177	30	147
Annual IC Time Burden (Hours)	195	33	162
Annual IC Cost Burden (Dollars)	0	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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