Information Collection

Ventilated Patient Form

IC 276085 under ICR 202507-0906-001 · OMB unassigned.

Documents and Forms

Document Name Document Type
Form 3 Ventilated Patient Form Form
Form 1 Ventilated Patient Form Ventilated Patient Form Form
Ventilated Patient Form_Instructions_CLEAN.docx Instruction
Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.docx Instruction
3 Ventilated Patient Form Ventilated Patient Form_CLEAN.xlsx Form
1 Ventilated Patient Form Ventilated Patient Form - OPTN Data Process 0906-NEW 11202025.xlsx Form
REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025.pdf REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025 IC Document
REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.pdf REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ventilated Patient 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	1	Ventilated Patient Form	Ventilated Patient Form - OPTN Data Process 0906-NEW 11202025.xlsx		Yes	Yes	Fillable Fileable
Instruction			Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act System of Records	FR Citation: 87 FR 46967

Number of Respondents: 56	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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	105,095	105,095
Annual IC Time Burden (Hours)	38,885	38,885
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025	REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025.pdf	12/01/2025
REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025	REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.pdf	12/01/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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