Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
B VCA Abdominal Wall Designated Program Application Removed 0 0 0 Form and Instruction B12 B12 VCA_AW_Kidney_Updated.doc
Form and Instruction B13 B13 VCA_AW_Liver_Updated.doc
Form and Instruction B14 B14 _VCA_AW_Pancreas_Updated.doc
Form and Instruction B15 B15 VCA_AW_Intestine_Updated.doc
B VCA Head and Neck Designated Program Application Removed 0 0 0 Form and Instruction B10 B VCA_Head and Neck_Updated.doc
B VCA Other Designated Program Application Removed 0 0 0 Form and Instruction B16 a B16 a VCA_Other_Updated.doc
Form and Instruction B16 b B16 b VCA_Other_NewTransplantProgram_Cover_HRSA.doc_.doc
Form and Instruction B16 c B16 c VCA_Other_PersonnelChange_Cover_HRSA.doc_.doc
F Change in Histocompatibility Lab Director Removed 0 0 0 Form and Instruction F F_HistoLab_PersonnelChange_Clean_HRSA.doc
G Change in OPO Key Personnel Removed 0 0 0 Form and Instruction G G_OPO_DirectorChange_final_clean_HRSA.doc
OPTN Business Membership Application Modified 2 2 0 Form and Instruction 16 Membership_Business Form.docx
OPTN Certificate of Assessment and Program Coverage Plan Membership Application Modified 2 6 0 Form and Instruction 2 Membership_CertificateAssessment_ProgramCoverage Form.docx
OPTN Individual Membership Application Modified 4 4 0 Form and Instruction 17 Membership_Individual Form.docx
OPTN Medical Scientific Membership Application Modified 7 7 0 Form and Instruction 14 Membership_MedicalScientific Form.docx
OPTN Membership Application Islet Transplant Program Modified 8 16 0 Form and Instruction 8 Membership_Pancreas Islet Form.docx
Form and Instruction 8B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application Modified 106 212 0 Form and Instruction 9 Membership_VCA Form.docx
Form and Instruction 9B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Heart Transplant Program Modified 284 852 0 Form and Instruction 6 Membership_Heart Form.docx
Form and Instruction 6B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Histocompatibility Labs Modified 54 162 0 Form and Instruction 12 Membership_HistoLab Form.docx
OPTN Membership Application for Intestine Transplant Programs Modified 180 540 0 Form and Instruction 10 Membership_Intestine Form.docx
Form and Instruction 10B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Kidney Transplant Programs Modified 378 1134 0 Form and Instruction 3 Membership_Kidney_LDKidney Form.docx
Form and Instruction 3B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Liver Transplant Progrms Modified 220 660 0 Form and Instruction 4 Membership_Liver_LDLiver Form.docx
Form and Instruction 4B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Lung Transplant Program Modified 120 360 0 Form and Instruction 7 Membership_Lung Form.docx
Form and Instruction 7B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for OPOs Modified 10 30 0 Form and Instruction 11 Membership_OPO Form.docx
OPTN Membership Application for Pancreas Transplant Programs Modified 240 720 0 Form and Instruction 5 Membership_Pancreas Form.docx
Form and Instruction 5B Membership_SurgeonOrPhysicianLog Form.docx
OPTN Membership Application for Transplant Hospitals Modified 2 6 0 Form and Instruction 1 Membership_Transplant Hospital_General Form.docx
OPTN Public Organization Membership Application Modified 4 4 0 Form and Instruction 15 Membership_PublicOrg Form.docx
OPTN Representative Form Modified 40 40 0 Form and Instruction 13 Membership_Representative Form.docx
Total burden requested under this ICR: 1661 4755 0  
To view an IC, click on IC Title