Organ Procurement & Transplantation Network Board of Directors and Committee Member Applications and Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8 Form 8. OPTN Volunteer Confidentiality Agreement - 0906-NEW - 10.21.2026	Form and Instruction	New	Available
Form 7 Form 7. OPTN Code of Conduct - 0906-NEW - 10.21.2026	Form and Instruction	New	Available
Form 6 Form 6. OPTN Attestation Form - 0906-NEW - 10.21.2026 (1)	Form and Instruction	New	Available
Form 5 Form 5. OPTN Ad Hoc Conflict-of-Interest Form - 0906-NEW - 10.21.2026	Form and Instruction	New	Available
Form 4 Form 4. OPTN Tri-Annual Conflict-of-Interest Form - 0906-NEW - 10.21.2026	Form and Instruction	New	Available
Form 3 Form 3. OPTN Annual Conflict-of-Interest Form - 0906-NEW - _10.21.2026	Form and Instruction	New	Available
Form 2 Form 2. OPTN Committee Volunteer Interest Form 09906-NEW - 10.21.2206	Form and Instruction	New	Available
Form 1 Form 1. OPTN BOD Volunteer Interest Form - 0906-NEW_10.21.2026 (1)	Form and Instruction	New	Available
Supporting Statement A - 0906-NEW- HSB - OPTN BOD and Committee Forms 10.27.2026.pdf	Supporting Statement A	Uploaded 2026-10-27	Available
1. Erickson_AOPO_09.25.2026 (1).pdf	Public Comments	Uploaded 2026-10-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
283297	8. OPTN Volunteer Confidentiality Agreement	Form and Instruction	New	Form 8. OPTN Volunteer Confidentiality Agreement - 0906-NEW - 10.21.2026
283296	7. OPTN Code-of-Conduct Form	Form and Instruction	New	Form 7. OPTN Code of Conduct - 0906-NEW - 10.21.2026
283295	6. OPTN Attestation Form	Form and Instruction	New	Form 6. OPTN Attestation Form - 0906-NEW - 10.21.2026 (1)
283294	5. OPTN Ad Hoc Conflict-of-Interest Form	Form and Instruction	New	Form 5. OPTN Ad Hoc Conflict-of-Interest Form - 0906-NEW - 10.21.2026
283293	4. OPTN Tri-Annual Conflict-of-Interest Form	Form and Instruction	New	Form 4. OPTN Tri-Annual Conflict-of-Interest Form - 0906-NEW - 10.21.2026
283290	3. OPTN Annual Conflict-of-Interest Form	Form and Instruction	New	Form 3. OPTN Annual Conflict-of-Interest Form - 0906-NEW - _10.21.2026
283289	2. OPTN Committee Volunteer Interest Form	Form and Instruction	New	Form 2. OPTN Committee Volunteer Interest Form 09906-NEW - 10.21.2206
283237	1. OPTN Board of Directors Volunteer Interest Form	Form and Instruction	New	Form 1. OPTN BOD Volunteer Interest Form - 0906-NEW_10.21.2026 (1)

ICR Details

OMB Control No:	ICR Reference No: 202610-0906-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Organ Procurement & Transplantation Network Board of Directors and Committee Member Applications and Forms
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/27/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	7,683	0
Time Burden (Hours)	2,111	0
Cost Burden (Dollars)	205,852	0

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Abstract: This package contains the Organ Procurement & Transplantation Network (OPTN) volunteer application documents used to collect information from individuals looking to serve as a member of the OPTN Board or Committees. The information collection includes the OPTN Board of Directors Application; OPTN Committee Application; OPTN conflict-of-interest (COI) forms (annual, tri-annual, and ad hoc); OPTN attestation form; OPTN code of conduct form; and OPTN confidentiality agreement. The OPTN is a public-private partnership that links professionals involved in the U.S. donation, procurement, and transplantation system. The OPTN focuses on promoting long, healthy, and productive lives for people with organ failure. The OPTN also aims to increase opportunities for transplants, optimize organ use, enhance efficiency, and prioritize patient care. The OPTN BOD is authorized by section 372 of the National Organ Transplant Act of 1984 (NOTA) (see 42 U.S.C. § 274(b)(1)(B)), and the operational composition of the OPTN BOD is further codified in federal regulation under the regulations implementing NOTA (see 42 C.F.R. § 121.3(a)). These regulations also provide that the OPTN BOD shall establish committees “as are necessary to perform the duties of the OPTN” and describe the composition of these committees (see 42 C.F.R. § 121.3(a)(4)). As part of the ongoing OPTN Modernization Initiative, HRSA seeks OMB approval of applications to be completed by candidates interested in volunteering to serve on the OPTN BOD and/or on the committees that support the BOD. Members of the OPTN BOD and committees do not receive payment for this work. HRSA also seeks approval of conflict-of-interest, code of conduct, confidentiality, and attestation forms to be completed by the selected/confirmed members of the OPTN BOD and committees on an annual, tri-annual, or ad hoc basis. The application forms are necessary to collect information regarding applicants' professional backgrounds, qualifications, expertise, experience in organ donation and transplantation, and areas of interest. The remaining forms support the ethical, operational, conflict-of-interest, and confidentiality requirements associated with service on the OPTN Board and committees.

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Authorizing Statute(s): US Code: 42 USC 274(b)(1)(B) Name of Law: PHS Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 50861	08/06/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 67589	10/27/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
1. OPTN Board of Directors Volunteer Interest Form	1	Form 1. OPTN BOD Volunteer Interest Form - 0906-NEW_10.21.2026 (1)
2. OPTN Committee Volunteer Interest Form	2	Form 2. OPTN Committee Volunteer Interest Form 09906-NEW - 10.21.2206
3. OPTN Annual Conflict-of-Interest Form	3	Form 3. OPTN Annual Conflict-of-Interest Form - 0906-NEW - _10.21.2026
4. OPTN Tri-Annual Conflict-of-Interest Form	4	Form 4. OPTN Tri-Annual Conflict-of-Interest Form - 0906-NEW - 10.21.2026
5. OPTN Ad Hoc Conflict-of-Interest Form	5	Form 5. OPTN Ad Hoc Conflict-of-Interest Form - 0906-NEW - 10.21.2026
6. OPTN Attestation Form	6	Form 6. OPTN Attestation Form - 0906-NEW - 10.21.2026 (1)
7. OPTN Code-of-Conduct Form	7	Form 7. OPTN Code of Conduct - 0906-NEW - 10.21.2026
8. OPTN Volunteer Confidentiality Agreement	8	Form 8. OPTN Volunteer Confidentiality Agreement - 0906-NEW - 10.21.2026

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,683	0	0	7,683	0	0
Annual Time Burden (Hours)	2,111	0	0	2,111	0	0
Annual Cost Burden (Dollars)	205,852	0	0	205,852	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New Collection

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Annual Cost to Federal Government: $2,999,798

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/27/2026

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