PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
OPTN Business Membership Application
Unchanged
2
2
0
Form and Instruction
16
Membership_Business Form.docx
OPTN Certificate of Assessment and Program Coverage Plan Membership Application
Unchanged
2
6
0
Form and Instruction
2
Membership_CertificateAssessment_ProgramCoverage Form.docx
OPTN Individual Membership Application
Unchanged
4
4
0
Form and Instruction
17
Membership_Individual Form.docx
OPTN Medical Scientific Membership Application
Unchanged
7
7
0
Form and Instruction
14
Membership_MedicalScientific Form.docx
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application
Modified
106
212
0
Form and Instruction
9
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs CLEAN
Form and Instruction
9 R
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs REDLINE
Form and Instruction
9 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
9 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE
OPTN Membership Application Islet Transplant Program
Modified
8
16
0
Form and Instruction
8
OPTN Membership Application for Islet Transplant Programs CLEAN
Form and Instruction
8 R
OPTN Membership Application for Islet Transplant Programs REDLINE
Form and Instruction
8 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
8 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE
OPTN Membership Application for Heart Transplant Program
Modified
284
852
0
Form and Instruction
6
OPTN Membership Application for Heart Transplant Programs CLEAN
Form and Instruction
6 R
OPTN Membership Application for Heart Transplant Programs REDLINE
Form and Instruction
6 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
6 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE
OPTN Membership Application for Histocompatibility Labs
Modified
54
162
0
Form and Instruction
12
OPTN Membership Application for Histocompatibility Laboratories CLEAN
Form and Instruction
12 R
OPTN Membership Application for Histocompatibility Laboratories REDLINE
OPTN Membership Application for Intestine Transplant Programs
Modified
180
540
0
Form and Instruction
10
OPTN Membership Application for Intestine Transplant Programs CLEAN
Form and Instruction
10 R
OPTN Membership Application for Intestine Transplant Programs REDLINE
Form and Instruction
10 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
10 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE
OPTN Membership Application for Kidney Transplant Programs
Modified
378
1134
0
Form and Instruction
3
OPTN Membership Application for Kidney Transplant Programs CLEAN
Form and Instruction
3 R
OPTN Membership Application for Kidney Transplant Programs REDLINE
Form and Instruction
3 B
OPTN Membership Application_Surgeon or Physician Log CLEAN.docx
Form and Instruction
3 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE.docx
OPTN Membership Application for Liver Transplant Progrms
Modified
220
660
0
Form and Instruction
4
OPTN Membership Application for Liver Transplant Programs CLEAN
Form and Instruction
4 R
OPTN Membership Application for Liver Transplant Programs REDLINE
Form and Instruction
4 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
4 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE.docx
OPTN Membership Application for Lung Transplant Program
Modified
120
360
0
Form and Instruction
7
OPTN Membership Application for Lung Transplant Programs CLEAN
Form and Instruction
7 R
OPTN Membership Application for Lung Transplant Programs REDLINE
Form and Instruction
7 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
7 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE
OPTN Membership Application for OPOs
Unchanged
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
OPTN Membership Application for Pancreas Transplant Programs CLEAN
Form and Instruction
5 R
OPTN Membership Application for Pancreas Transplant Programs REDLINE
Form and Instruction
5 B
OPTN Membership Application_Surgeon or Physician Log CLEAN
Form and Instruction
5 BR
OPTN Membership Application_Surgeon or Physician Log REDLINE
OPTN Membership Application for Transplant Hospitals and Programs
Modified
2
6
0
Form and Instruction
1
OPTN Membership Application for Transplant Hospitals and Programs CLEAN.docx
Form and Instruction
1 R
OPTN Membership Application for Transplant Hospitals and Programs REDLINE.docx
OPTN Public Organization Membership Application
Unchanged
4
4
0
Form and Instruction
15
Membership_PublicOrg Form.docx
OPTN Representative Form
Unchanged
40
40
0
Form and Instruction
13
Membership_Representative Form.docx
Total burden requested under this ICR:
1661
4755
0
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