Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Additional Surgeon and Physician Request Form Modified 125 146 0 Form and Instruction 20 Additional Surgeon and Physician Request Form
Form and Instruction 20S (Revised 03.25) Additional Surgeon and Physician Request Form
HOPE Act Variance Request Form Modified 0 0 0 Form and Instruction 21 Hope Act Variance Request Form
Form and Instruction 21T (03.25 Version) Hope Act Variance Request Form
Kidney Paired Donation Pilot Program (KPDPP) contact update Form Modified 52 85 0 Form and Instruction 23 Kidney Paired Donation Pilot Program (KPDPP) contact update Form
Form and Instruction 23U (03.25 Version) Kidney Paired Donation Pilot Program (KPDPP) Contact Update Form
OPTN Business Membership Application Modified 6 5 0 Form and Instruction 16 OPTN Membership_Business Form
Form and Instruction 16O (03.25 version) OPTN Business Membership Application
OPTN Individual Membership Application Modified 7 2 0 Form and Instruction 17 OPTN Membership_Individual Form
Form and Instruction 17P (03.25 version) OPTN Individual Membership Application
OPTN Medical Scientific Membership Application Modified 3 2 0 Form and Instruction 14 Membership_MedicalScientific Form.docx
Form and Instruction 14M (03.25 Version) OPTN MedicalScientific Membership Application
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
Form and Instruction 9V (03.25 version) OPTN Membership Application Surgeon or Physician Log
Form and Instruction 9H (03.25 version) OPTN Membership Application for VCA Transplant Programs
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
Form and Instruction 8V (03.25 version) OPTN Membership Application Surgeon or Physician Log
Form and Instruction 8G (03.25 version) OPTN Membership Application for Islet Transplant Programs
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
Form and Instruction 6E (03.25 version) OPTN Membership Application for Heart Transplant Programs
Form and Instruction 6V (03.25 version) OPTN Membership Application Surgeon or Physician Log
OPTN Membership Application for Histocompatibility Labs Modified 30 75 0 Form and Instruction 12 OPTN Membership Application for Histocompatibility Laboratories
Form and Instruction 12K (03.25 Version) OPTN Membership Histocompatibility Laboratory Application
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
Form and Instruction 10V (03.25 version) OPTN Membership Application Surgeon or Physician Log
Form and Instruction 10I (03.25 version) OPTN Membership Application for Intestine Transplant Programs
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
Form and Instruction 3B (03.25 version) OPTN Membership Application for Kidney Transplant Programs
Form and Instruction 3V (03.25 version) OPTN Membership Application Surgeon or Physician Log
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
Form and Instruction 4C (03.25 version) OPTN Membership Application for Liver Transplant Programs
Form and Instruction 4V (03.25 version) OPTN Membership Application Surgeon or Physician Log
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
Form and Instruction 7V (03.25 version) OPTN Membership Application Surgeon or Physician Log
Form and Instruction 7F (03.25 version) OPTN Membership Application for Lung Transplant Programs
OPTN Membership Application for OPOs Modified 8 320 0 Form and Instruction 11 Membership_OPO Form.docx
Form and Instruction 11J (03.25 Version) OPTN Membership Application for Organ Procurement Organizations
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
Form and Instruction 5D (03.25 version) OPTN Membership Application for Pancreas Transplant Programs
Form and Instruction 5V (03.25 version) OPTN Membership Application Surgeon or Physician Log
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
Form and Instruction 1A (03.25 version) OPTN Membership Application for Transplant Hospitals and Programs
Form and Instruction 1V (03.25 version) OPTN Membership Application Surgeon or Physician Log
OPTN Public Organization Membership Application Modified 4 2 0 Form and Instruction 15 Membership_PublicOrg Form.docx
Form and Instruction 15N (03.25 Version) OPTN Public Organization Membership Application
OPTN Representative Form Modified 35 9 0 Form and Instruction 13 OPTN Membership_Representative Form.docx
Form and Instruction 13L (03.25 Version) OPTN Representative Form
Primary Data Coordinator Form Modified 53 7 0 Form and Instruction 19 Primary Data Coordinator
Form and Instruction 19R (03.25 version) Primary Data Coordinator Form
Primary Program Administrator Form Modified 78 20 0 Form and Instruction 18 Primary Program Administrator Form
Form and Instruction 18Q (03.25 version) Primary Program Administrator Form
Total burden requested under this ICR: 858 5610 0  
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