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 Modified 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
Form and Instruction 9 09_OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs CLEAN 10072024
Form and Instruction 9 09_OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs REDLINE 10072024
OPTN Membership Application Islet Transplant Program Modified 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
Form and Instruction 8 08_OPTN Membership Application for Islet Transplant Programs CLEAN 10072024
Form and Instruction 8 08_OPTN Membership Application for Islet Transplant Programs REDLINE 10072024
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
Form and Instruction 6 06_OPTN Membership Application for Heart Transplant Programs CLEAN 10072024
Form and Instruction 6 06_OPTN Membership Application for Heart Transplant Programs REDLINE 10072024
OPTN Membership Application for Histocompatibility Labs Unchanged 30 75 0 Form and Instruction 12 OPTN Membership Application for Histocompatibility Laboratories
OPTN Membership Application for Intestine Transplant Programs Modified 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
Form and Instruction 10 10_OPTN Membership Application for Intestine Transplant Programs CLEAN 10072024
Form and Instruction 10 10_OPTN Membership Application for Intestine Transplant Programs REDLINE 10072024
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
Form and Instruction 3 03_OPTN Membership Application for Kidney Transplant Programs CLEAN 10072024
Form and Instruction 3 03_OPTN Membership Application for Kidney Transplant Programs REDLINE 10072024
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
Form and Instruction 4 04_OPTN Membership Application for Liver Transplant Programs CLEAN 10072024
Form and Instruction 4 04_OPTN Membership Application for Liver Transplant Programs REDLINE 10072024
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
Form and Instruction 7 07_OPTN Membership Application for Lung Transplant Programs CLEAN 10072024
Form and Instruction 7 07_OPTN Membership Application for Lung Transplant Programs REDLINE 10072024
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
Form and Instruction 5 05_OPTN Membership Application for Pancreas Transplant Programs CLEAN 10072024
Form and Instruction 5 05_OPTN Membership Application for Pancreas Transplant Programs REDLINE 10072024
OPTN Membership Application for Transplant Hospitals and Programs Modified 70 280 0 Form and Instruction 1 OPTN Membership Application for Transplant Hospitals and Programs.docx
Form and Instruction 1 01_OPTN Membership Application for Transplant Hospitals and Programs CLEAN 10072024
Form and Instruction 1 01_OPTN Membership Application for Transplant Hospitals and Programs REDLINE 10072024
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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