Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Death Notification Referal - Eligible Removed 0 0 0 Form 1 Death Notification Referral Eligible
Instruction
Death Notification Referral-Imminent Removed 0 0 0 Form 1 Death Notification Referral Imminent
Instruction
Death Referral Data Removed 0 0 0 Form 1 Death Referral Data
Instruction
Heart, Lung, Heart/Lung Follow Up (1-5 year) New 16139 17753 0 Form and Instruction 21 Heart, Lung, Heart/Lung Follow Up (1-5 year)
Heart, Lung, Heart/Lung Follow Up (6 month) New 3923 3138 0 Form and Instruction 20 Heart, Lung, Heart/Lung Follow Up (6 month)
Heart, Lung, Heart/Lung Follow Up (Post 5 year) New 19485 11691 0 Form and Instruction 22 Heart, Lung, Heart/Lung Follow Up (Post 5 year)
Heart, Lung, Heart/Lung Recipient Registration New 4471 6259 0 Form and Instruction 19 Heart, Lung, Heart/Lung Recipient Registration
Kidney/Pancreas Modified 25029 21188 0 Form and Instruction 45 Kidney/Pancreas Candidate Registration
Form and Instruction 46 Kidney/Pancreas Recipient Registration
Form and Instruction 47 Kidney/Pancreas Recipient Follow up (6 months - 5 years)
Form and Instruction 48 Kidney/Pancreas Recipient Follow up (Post 5 years)
Liver Explant Pathology Removed 0 0 0 Form 1 Liver Recipient Explant Pathology Worksheet
Instruction
Liver Recipient Explant Pathology Form New 1659 995 0 Form and Instruction 28 Liver Recipient Explant Pathology Form
OPTN- Deceased Donor Registration Worksheet Modified 9176 10093 0 Form and Instruction 1 Deceased Donor Registration
OPTN- Donor Histocompatibility Modified 14599 2920 0 Form and Instruction 4 Donor Histocompatibility
OPTN- Heart Candidate Registration Modified 3996 3596 0 Form and Instruction 6 Heart Transplant Candidate Registration
OPTN- Heart/Lung Candidate Registration Modified 44 48 0 Form and Instruction 18 Heart/Lung Candidate Registration
OPTN- Intestine Candidate Registration Modified 180 234 0 Form and Instruction 30 Intestine Candidate Registration
OPTN- Intestine Follow-up Modified 1099 1040 0 Form and Instruction 32 Intestine Recipient Follow Up (6 months - 5 years)
Form and Instruction 33 Intestine Recipient Follow Up (Post 5 years)
OPTN- Intestine Recipient Registration Modified 111 200 0 Form and Instruction 31 Intestine Recipient Registration
OPTN- Kidney Candidate Registration Modified 37882 30306 0 Form and Instruction 35 Kidney Candidate Registration
OPTN- Kidney Follow-up Modified 169200 119972 0 Form and Instruction 37 Kidney Follow-up (6 months - 5 years)
Form and Instruction 38 Kidney Follow-up (Post 5 years)
OPTN- Kidney Recipient Registration Modified 16897 21966 0 Form and Instruction 36 Kidney Recipient Registration
OPTN- Kidney/Pancreas Registration Removed 0 0 0 Instruction
Form 19 Kidney-Pancreas Adult Transplant Recipient Registration
Form 19b Kidney-Pancreas Pediatric Tranplant Recipient Registration Worksheet
OPTN- Liver Candidate Registration Modified 12050 9640 0 Form and Instruction 24 Liver Candidate Registration
OPTN- Liver Follow-up Modified 65824 48511 0 Form and Instruction 26 Liver Recipient Follow up (6 months - 5 years)
Form and Instruction 27 Liver Recipient Follow up (Post 5 years)
OPTN- Liver Recipient Registration Modified 6460 8398 0 Form and Instruction 25 Liver Recipient Registration
OPTN- Living Donor Registration Modified 5979 10763 0 Form and Instruction 2 Living Donor Registration
OPTN- Lung Candidate Registration Modified 2535 2282 0 Form and Instruction 12 Lung Candidate Registration
OPTN- Pancreas Follow-up Removed 0 0 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 Removed 0 0 0 Instruction
Form 22 Pancreas Adult Transplant Recipient Registration Worksheet
Form 22b Pancreas Pediatric Transplant Recipient Registration Worksheet
OPTN- Post Transplant Malignancy Removed 0 0 0 Instruction
Form 27 Adult Post Transplant Malignancy Worksheet
Form 27b Pediatric Post Transplant Malignancy Worksheet
OPTN- Recipient Histocompatibility Modified 26195 10478 0 Form and Instruction 5 Recipient Histocompatibility
OPTN- Thoracic Follow-up Removed 0 0 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 Removed 0 0 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 Removed 0 0 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 17612 22896 0 Form and Instruction 3 Living Donor Follow Up
Pancreas Modified 3942 3016 0 Form and Instruction 40 Pancreas Candidate Registration
Form and Instruction 41 Pancreas Recipient Registration
Form and Instruction 42 Pancreas Recipient Follow Up (6 months - 5 years)
Form and Instruction 43 Pancreas Recipient Follow Up (Post 5 years)
Pancreas Islet Candidate Registration Removed 0 0 0 Form 1 Pancreas Islets Adult
Form 2 Pancreas Islets Pediatric
Instruction
Post-Transplant Malignancy Form New 7888 6307 0 Form and Instruction 11 Post-Transplant Malignancy Form
Vascular Composite Allograft New 43 39 0 Form and Instruction 50 Vascular Composit Allograft Candidate Registration
Instruction
Form and Instruction 51 Vascular Composit Allograft Recipient Registration
Form and Instruction 52 Vascular Composit Allograft Recipient Follow Up
Total burden requested under this ICR: 472418 373729 0  
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