OPTN Renal Waiting Time Reinstatement Form

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
Form 103 OPTN Renal Waiting Time Reinstatement Form Form
103. OPTN Renal Time Reinstatement Form_Instructions.docx Instruction
103 Renal Waiting Time Reinstatement Form 103. OPTN Renal Waiting Time Reinstatement Form_Form.xlsx Form

Information Collection (IC) Details

IC Title:	OPTN Renal Waiting Time Reinstatement Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	103	Renal Waiting Time Reinstatement Form	103. OPTN Renal Waiting Time Reinstatement Form_Form.xlsx		Yes	Yes	Fillable Fileable
Instruction			103. OPTN Renal Time Reinstatement Form_Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act System of Records 09-15-0055	FR Citation: 87 FR 46967

Number of Respondents: 228	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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	276	276
Annual IC Time Burden (Hours)	75	75
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.