Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Additional Surgeon and Physician Request Form Unchanged 125 146 0 Form and Instruction 20 Additional Surgeon and Physician Request Form
HOPE Act Variance Request Form Unchanged 0 0 0 Form and Instruction 21 Hope Act Variance Request Form
Kidney Paired Donation Pilot Program (KPDPP) contact update Form Unchanged 52 85 0 Form and Instruction 23 Kidney Paired Donation Pilot Program (KPDPP) contact update Form
OPTN Business Membership Application Unchanged 6 5 0 Form and Instruction 16 OPTN Membership_Business Form
OPTN Individual Membership Application Unchanged 7 2 0 Form and Instruction 17 OPTN Membership_Individual Form
OPTN Medical Scientific Membership Application Unchanged 3 2 0 Form and Instruction 14 Membership_MedicalScientific Form.docx
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Program Application Unchanged 42 651 0 Form and Instruction 9 OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs
Form and Instruction 9 B OPTN Membership Application_Surgeon or Physician Log
OPTN Membership Application Islet Transplant Program Unchanged 0 0 0 Form and Instruction 8 OPTN Membership Application for Islet Transplant Programs CLEAN
Form and Instruction 8 B OPTN Membership Application_Surgeon or Physician Log
OPTN Membership Application for Heart Transplant Program Modified 49 1005 0 Form and Instruction 6 B OPTN Membership Application_Surgeon or Physician Log
Form and Instruction 6 OPTN Membership Application for Heart Transplant Programs
OPTN Membership Application for Histocompatibility Labs Modified 30 75 0 Form and Instruction 12 OPTN Membership Application for Histocompatibility Laboratories
OPTN Membership Application for Intestine Transplant Programs Unchanged 4 44 0 Form and Instruction 10 OPTN Membership Application for Intestine Transplant Programs
Form and Instruction 10 B OPTN Membership Application_Surgeon or Physician Log
OPTN Membership Application for Kidney Transplant Programs Modified 131 1048 0 Form and Instruction 3 B OPTN Membership Application_Surgeon or Physician Log.docx
Form and Instruction 3 OPTN Membership Application for Kidney Transplant Programs
OPTN Membership Application for Liver Transplant Progrms Modified 84 1092 0 Form and Instruction 4 B OPTN Membership Application_Surgeon or Physician Log
Form and Instruction 4 OPTN Membership Application for Liver Transplant Programs
OPTN Membership Application for Lung Transplant Program Modified 46 414 0 Form and Instruction 7 B OPTN Membership Application_Surgeon or Physician Log
Form and Instruction 7 OPTN Membership Application for Lung Transplant Programs
OPTN Membership Application for OPOs Unchanged 8 320 0 Form and Instruction 11 Membership_OPO Form.docx
OPTN Membership Application for Pancreas Transplant Programs Modified 31 403 0 Form and Instruction 5 B OPTN Membership Application_Surgeon or Physician Log
Form and Instruction 5 OPTN Membership Application for Pancreas Transplant Programs
OPTN Membership Application for Transplant Hospitals and Programs Unchanged 70 280 0 Form and Instruction 1 OPTN Membership Application for Transplant Hospitals and Programs.docx
OPTN Public Organization Membership Application Unchanged 4 2 0 Form and Instruction 15 Membership_PublicOrg Form.docx
OPTN Representative Form Unchanged 35 9 0 Form and Instruction 13 OPTN Membership_Representative Form.docx
Primary Data Coordinator Form Unchanged 53 7 0 Form and Instruction 19 Primary Data Coordinator
Primary Program Administrator Form Unchanged 78 20 0 Form and Instruction 18 Primary Program Administrator Form
Total burden requested under this ICR: 858 5610 0  
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