View Information Collection (IC)

View Information Collection (IC)

IC Title:	OPTN- Intestine Follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	26b	Intestine Pediatric Follow-up	TRF Intestine Pediatric Wksheet.pdf		Yes	Yes	Fillable Fileable
Form	26	Intestine Follow-up	TRF Intestine Adult Wksheet.pdf		Yes	Yes	Fillable Fileable
Form	26c	Post 5-Year Intestine Follow-up	TRF Post 5-Year All Organs Adult Wksheet.pdf		Yes	Yes	Fillable Fileable
Form	26d	Post 5-Year Intestine Pediatric Follow-up	TRF Post 5-Year All Organs Pediatric Wksheet.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 44	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,232	0	0	467	0	765
Annual IC Time Burden (Hours)	1,047	0	0	660	0	387
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transplant Recipient Follow-up - Intestine	Transplant Recipient Follow-up - Intestine.doc	09/14/2010
Transplant Recipient Follow-up - Intestine - Post 5-Year	Transplant Recipient Follow-up - Intestine - Post 5-Year.doc	09/14/2010

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