Information Collection

Heart/Lung Recipient Registration

IC 214124 under ICR 202610-0906-001 · OMB 0906-0110.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 19 Heart/Lung Transplant Recipient Registration_Form_clean.xlsx Heart/Lung Recipient Registration	Form
19. HeartLung Transplant Recipient Registration_Instructions.docx	Instruction
19. HeartLung Transplant Recipient Registration_Form_redline.xlsx	Other-Redline
19 Heart/Lung Transplant Recipient Registration_Form_clean. 19. HeartLung Transplant Recipient Registration_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	19	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: 75

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60	6	54
Annual IC Time Burden (Hours)	125	12	113
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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