Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Death Notification Referal - Eligible Modified 8410 4205 0 Form 1 Death Notification Referral Eligible
Instruction
Death Notification Referral-Imminent Modified 7192 3596 0 Form 1 Death Notification Referral Imminent
Instruction
Death Referral Data Modified 696 6960 0 Form 1 Death Referral Data
Instruction
Liver Explant Pathology New 1452 494 0 Form 1 Liver Recipient Explant Pathology Worksheet
Instruction
OPTN- Deceased Donor Registration Worksheet Modified 13224 9918 0 Form 1 Deceased Donor Registration
Instruction
OPTN- Donor Histocompatibility Modified 14852 1485 0 Form 1 Donor Histocompatibility
Instruction
OPTN- Heart Candidate Registration Modified 3537 1769 0 Instruction
Form 7 Heart Adult Candidate Transplant Registration
Form 7b Heart Pediatric Transplant Candidate Registration
OPTN- Heart/Lung Candidate Registration Modified 50 25 0 Instruction
Form 9 Heart-Lung Adult Transplant Candidate Registration Worksheet
Form 9b Heart-Lung Pediatric Transplant Candidate Registration Worksheet
OPTN- Intestine Candidate Registration Modified 215 108 0 Instruction
Form 24 Intestine Adult Transplant Candidate Registration Worksheet
Form 24b Intestine Pediatric Transplant Candidate Registration Worksheet
OPTN- Intestine Follow-up Modified 1075 914 0 Instruction
Instruction
Form 26 Intestine Adult Post 5 Year Transplant Recipient Follow Up Worksheet
Form 26b Intestine Adult Transplant Recipient Follow Up Worksheet
Form 26c Intestine Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet
Form 26d Intestine Pediatric Transplant Recipient Follow Up Worksheet
OPTN- Intestine Registration Modified 129 116 0 Instruction
Form 25 Intestine Adult Transplant Recipient Registration Worksheet
Form 25b Intestine Pediatric Transplant Recipient Registration Worksheet
OPTN- Kidney Candidate Registration Modified 36806 18403 0 Form 1 Kidney Adult Candidate Registration
Form 2 Kidney Pediatric Transplant
Instruction
OPTN- Kidney Follow-up Modified 165627 91095 0 Instruction
Instruction
Form 14 Kidney Adult Post 5 year Transplant Recipient Follow Up worksheet
Form 14b Kidney Adult Transplant Recipient Follow Up Worksheet
Form 14c Kidney Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet
Form 14d Kidney Pediatric Transplant Recipient Follow Up Worksheet
OPTN- Kidney Registration Modified 17208 12906 0 Form 1 Kidney Adult Transplant Recipient Registration
Form 2 Kidney Pediatric Transplant Recipient Registration
Instruction
OPTN- Kidney/Pancreas Candidate Registration Modified 1584 792 0 Instruction
Form 18 Kidney-Pancreas Adult Transplant Candidate Registration Worksheet
Form 18b Kidney-Pancreas Pediatric Transplant Candidate Registration Worksheet
OPTN- Kidney/Pancreas Registration Modified 864 778 0 Instruction
Form 19 Kidney-Pancreas Adult Transplant Recipient Registration
Form 19b Kidney-Pancreas Pediatric Tranplant Recipient Registration Worksheet
OPTN- Liver Candidate Registration Modified 12936 6468 0 Instruction
Form 15 Liver Adullt Transplant candidate Registration Worksheet
Form 15b Liver Pediatric Transplant candidate Registration Worksheet
OPTN- Liver Follow-up Modified 60588 30294 0 Form 17 Liver Adult Post 5 year Transplant Recipient Follow Up Worksheet
Instruction
Instruction
Form 17c Liver Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet
Form 17b Liver Adult Transplant Recipient Follow Up Worksheet
Form 17d Liver Pediatric Transplant Recipient Follow Up Worksheet
OPTN- Liver Registration Modified 6336 4118 0 Instruction
Form 16 Liver Adult Transplant Recipient Registration Worksheet
Form 16b Liver Pediatric Transplant Recipient Registration Worksheet
OPTN- Living Donor Registration Modified 7153 4649 0 Form 1 Living Donor Registration
Instruction
OPTN- Lung Candidate Registration Modified 2706 1353 0 Form 8 Lung Adult Transplant candidate Registration Worksheet
Form 8b Lung Pediatric Transplant candidate Registration Worksheet
Instruction
OPTN- Pancreas Candidate Registration Modified 576 288 0 Instruction
Form 21 Pancreas and Pancreas Islets Adult Transplant Candidate Registration Worksheet
Form 21b Pancreas and Pancreas Islets Pediatric Tranpslant Candidate Registration Worksheet
OPTN- Pancreas Follow-up Modified 3312 2153 0 Instruction
Instruction
Form 23 Pancreas Adult Post 5 Year Transplant Recipient Follow Up Worksheet
Form 23b Pancreas Adult Transplant Recipient Follow Up Worksheet
Form 23c Pancreas Pediatric Post 5 Year Transplant Recipient Follow Up Worksheet
Form 23d Pancreas Pediatric Transplant Recipient Follow Up Worksheet
OPTN- Pancreas Registration Modified 288 216 0 Instruction
Form 22 Pancreas Adult Transplant Recipient Registration Worksheet
Form 22b Pancreas Pediatric Transplant Recipient Registration Worksheet
OPTN- Post Transplant Malignancy Modified 7579 1516 0 Instruction
Form 27 Adult Post Transplant Malignancy Worksheet
Form 27b Pediatric Post Transplant Malignancy Worksheet
OPTN- Recipient Histocompatibility Modified 27018 5404 0 Form 1 Recipient Histocompatibility
Instruction
OPTN- Thoracic Follow-up Modified 36287 23587 0 Form 1 Thoracic Heart Adult 6 month Follow-up
Form 2 Thoracic Heart Adult Post 5 year
Form 5 Thoracic Heart Pediatric Post 5 Follow Up
Form 7 Thoracic Heart Lung Adult Six month
Form 8 Thoracic Heart Lung Adult Post 5
Form 11 Thoracic Heart Lung Pediatric Post 5
Form 13 Thoracic Lung Adult 6 month Follow UP
Form 14 Thoracic Lung Adult Post 5 Follow Up
Form 17 Thoracic Lung Pediatric Post 5
Instruction
Instruction
Instruction
Form 3 Thoracic Heart Adult Transplant Recipient Follow Up
Form 4 Thoracic Heart Pediatric 6 Month Transplant Recipient Follow Up
Form 6 Thoracic Heart Pediatric Transplant Recipient Follow Up
Form 9 Thoracic Heart Lung Adult Transplant Recipient Follow Up
Form 10 Thoracic Heart Lung Pediatric 6 Month Transplant Recipient Follow Up
Form 12 Thoracic Heart Lung Pediatric Transplant Recipient Follow Up
Form 15 Thoracic Lung Adult Transplant Recipient Follow Up
Form 16 Thoracic Lung Pediatric 6 Month Transplant Recipient Follow Up
Form 18 Thoracic Lung Pediatric Transplant Recipient Follow Up
OPTN- Thoracic Registration Modified 4454 3341 0 Instruction
Form 10 Thoracic Heart Adult Transplant Recipient Registration Worksheet
Form 10b Thoracic Heart Pediatric Transplant Recipient Registration Worksheet
Form 10c Thoracic Heart-Lung Adult Transplant Recipient Regisration Worksheet
Form 10d Thoracic Heart-Lung Pediatric Transplant Recipient Registration Worksheet
Form 10e Thoracic Lung Adult Transplant Recipient Registration Worksheet
Form 10f Thoracic Lung Pediatric Transplant Recipient Registration Worksheet
OPTN- Kidney/Pancreas Follow-up Modified 10800 9180 0 Instruction
Instruction
Form 20 Kidney-Pancreas Adult Post 5 Year Transplant Recipient Follow Up Worksheet
Form 20b Kidney-Pancreas Adult Transplant Recipient Follow Up Worksheet
Form 20c Kidney-Pancreas Pediatric Post 5 Year Transplant Recipient Follow Up Workshseet
Form 20d Kidney-Pancreas Pediatric Transplant Recipient Follow Up Worksheet
OPTN- Living Donor Follow-up Modified 24258 12129 0 Instruction
Form 1 Living Donor Follow-up
Pancreas Islet Candidate Registration New 115 58 0 Form 1 Pancreas Islets Adult
Form 2 Pancreas Islets Pediatric
Instruction
Total burden requested under this ICR: 477327 258318 0  
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