Information Collection

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

IC 214128 under ICR 202508-0906-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 22 Heart/Lung Transplant Recipient Follow Up Post 5 Year_Form.xlsx Heart/Lung Transplant Recipient Follow Up Post 5 Year (TRF)	Form
22. HeartLung Transplant Recipient Follow Up Post 5 Year_Instructions.docx	Instruction
22. HeartLung Transplant Recipient Follow Up Post 5 Year_Form_redline.xlsx	Other-Redline
22 Heart/Lung Transplant Recipient Follow Up Post 5 Year_Fo 22. HeartLung Transplant Recipient Follow Up Post 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	22	Yes	Yes	Fillable Fileable
Other-Redline		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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	241	6	235
Annual IC Time Burden (Hours)	145	4	141
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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