Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Heart Candidate Listing Registration New 5003 4152 0 Instruction
Form 83
Adult Heart and HeartLung Status 1 Criteria 1 Extension Justification Form Medical Urgency Data New 64 34 0 Form 133
Instruction
Adult Heart and HeartLung Status 1 Exception Extension Justification Form Medical Urgency Data New 69 23 0 Instruction
Form 132
Adult Heart and HeartLung Status 1 Initial Justification Form Medical Urgency Data New 848 492 0 Form 131
Instruction
Adult Heart and HeartLung Status 1-6 Justification Form Demographic Data New 20231 6474 0 Form 129
Instruction
Adult Heart and HeartLung Status 1-6 Justification Form Risk Stratification Data New 20231 14566 0 Instruction
Form 130
Adult Heart and HeartLung Status 2 Criteria 1 Extension Justification Form Medical Urgency Data New 4 2 0 Instruction
Form 136
Adult Heart and HeartLung Status 2 Criteria 4 Extension Justification Form Medical Urgency Data New 454 286 0 Form 137
Instruction
Adult Heart and HeartLung Status 2 Criteria 5 Extension Justification Form Medical Urgency Data New 253 152 0 Instruction
Form 138
Adult Heart and HeartLung Status 2 Exception Extension Justification Form Medical Urgency Data New 1471 485 0 Form 135
Instruction
Adult Heart and HeartLung Status 2 Initial Justification Form Medical Urgency Data New 3861 3089 0 Instruction
Form 134
Adult Heart and HeartLung Status 3 Criteria 2 Extension Justification Form Medical Urgency Data New 95 30 0 Form 141
Instruction
Adult Heart and HeartLung Status 3 Criteria 5 Extension Justification Form Medical Urgency Data New 16 8 0 Instruction
Form 142
Adult Heart and HeartLung Status 3 Exception Extension Justification Form Medical Urgency Data New 1025 338 0 Instruction
Form 140
Adult Heart and HeartLung Status 3 Initial Justification Form Medical Urgency Data New 1775 1118 0 Form 139
Instruction
Adult Heart and HeartLung Status 4 Criteria 2 Extension Justification Form Medical Urgency Data New 83 33 0 Form 145
Instruction
Adult Heart and HeartLung Status 4 Exception Extension Justification Form Medical Urgency Data New 258 65 0 Instruction
Form 144
Adult Heart and HeartLung Status 4 Initial Justification Form Medical Urgency Data New 3503 1752 0 Form 143
Instruction
Adult HeartLung Candidate Listing Registration New 70 60 0 Form 85
Instruction
Adult Intestine Candidate Listing Registration New 89 34 0 Instruction
Form 81
Adult Kidney Candidate Listing Registration New 46724 24296 0 Form 71
Instruction
Adult Kidney Pancreas Candidate Listing Registration New 1590 588 0 Instruction
Form 73
Adult Liver Candidate Listing Registration New 13977 4473 0 Instruction
Form 79
Adult Liver Status 1A Initial Justification and Extension Form New 328 187 0 Instruction
Form 108
Adult Lung Candidate Listing Registration New 3319 3319 0 Form 87
Instruction
Adult Pancreas Candidate Listing Registration New 1881 715 0 Instruction
Form 75
Adult Pancreas Islet Listing Registration New 33 13 0 Instruction
Form 77
Adult and Pediatric Lung and HeartLung Goal Exception Form New 554 416 0 Instruction
Form 146
Candidate Registration Listing Removal New 71739 12913 0 Form 89
Instruction
Death Notification Registration Modified 16223 6814 0 Instruction
Form 66
Other-Redline
Deceased Donor Death Referral Modified 3254 1627 0 Instruction
Form 67
Other-Redline
Deceased Donor Registration (DDR) Modified 23224 11148 0 Form 1
Other-Redline
Instruction
Discrepant HLA Typings Reporting Form New 108 558 0 Instruction
Form 152
Disease Transmission Event Modified 708 425 0 Instruction
Form 58
Other-Redline
Donor Histocompatibility Form Modified 23917 4783 0 Instruction
Form 4
Donor Hospital Registration Modified 2 0 0 Instruction
Form 68
Donor Organ Disposition Modified 23224 3948 0 Instruction
Form 69
Other-Redline
Extra Vessels Reporting Form New 13320 400 0 Instruction
Form 150
Heart Post-Transplant Malignancy Form Modified 1819 1637 0 Instruction
Form 11
Heart Transplant Candidate Registration (TCR) Modified 5737 5163 0 Instruction
Form 6
Other-Redline
Heart Transplant Recipient Follow Up (6 months) Modified 4141 1656 0 Instruction
Form 8
Other-Redline
Heart Transplant Recipient Follow Up 1-5 Year Modified 16272 14645 0 Instruction
Form 9
Other-Redline
Heart Transplant Recipient Follow Up Post 5 Year Modified 27376 13688 0 Instruction
Form 10
Other-Redline
Heart Transplant Recipient Registration (TRR) Modified 4545 8908 0 Instruction
Form 7
Other-Redline
Heart/Lung Post Transplant Malignancy (PTM) Form Modified 16 6 0 Instruction
Form 23
Heart/Lung Recipient Registration Modified 54 113 0 Instruction
Form 19
Other-Redline
Heart/Lung Transplant Candidate Registration (TCR) Modified 74 86 0 Instruction
Form 18
Other-Redline
Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF) Modified 177 195 0 Instruction
Form 21
Other-Redline
Heart/Lung Transplant Recipient Follow Up 6 Month (TRF) Modified 46 37 0 Instruction
Form 20
Other-Redline
Heart/Lung Transplant Recipient Follow Up Post 5 Year (TRF) Modified 241 145 0 Instruction
Form 22
Other-Redline
Initial Donor Registration Modified 23224 107063 0 Instruction
Form 63
Other-redline
Interim Event Reporting Form New 18000 1080 0 Form 153
Instruction
Intestinal Waiting Time Reinstatement Form New 0 0 0 Form 105
Instruction
Intestine Post Transplant Malignancy (PTM) Form Modified 17 17 0 Instruction
Form 34
Intestine Transplant Candidate Registration (TCR) Modified 135 176 0 Instruction
Form 30
Other-Redline
Intestine Transplant Recipient Follow Up 6 Month -5 Year (TRF) Modified 387 581 0 Instruction
Form 32
Other-Redline
Intestine Transplant Recipient Follow Up Post 5 Year (TRF) Modified 893 357 0 Instruction
Form 33
Other-Redline
Intestine Transplant Recipient Registration (TRR) Modified 95 171 0 Instruction
Form 31
Other-Redline
Kidney Minimum Acceptance Criteria New 107 32 0 Form 107
Instruction
Kidney Paired Donation Candidate Registration Modified 53 14 0 Instruction
Form 55
Other-redline
Kidney Paired Donation Donor Registration Modified 154 166 0 Instruction
Form 56
Other-redline
Kidney Paired Donation Match Offer Management Modified 92 62 0 Instruction
Form 57
Kidney Post Transplant Malignancy (PTM) Form Modified 5837 4670 0 Instruction
Form 39
Kidney Transplant Candidate Registration (TCR) Modified 46311 37049 0 Instruction
Form 35
Other-Redline
Kidney Transplant Recipient Follow Up 6 Month -5 Year (TRF) Modified 130238 117214 0 Instruction
Form 37
Other-Redline
Kidney Transplant Recipient Follow Up Post 5 Year (TRF) Modified 128955 64478 0 Instruction
Form 38
Other-Redline
Kidney Transplant Recipient Registration (TRR) Modified 27335 32802 0 Instruction
Form 36
Other-Redline
Kidney/Pancreas Post Transplant Malignancy (PTM) Form Modified 276 110 0 Instruction
Form 49
Kidney/Pancreas Transplant Candidate Registration (TCR) Modified 1592 955 0 Instruction
Form 45
Other-Redline
Kidney/Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF) Modified 4689 2345 0 Instruction
Form 47
Other-Redline
Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year (TRF) Modified 8195 4917 0 Instruction
Form 48
Other-redline
Kidney/Pancreas Transplant Recipient Registration (TRR) Modified 811 973 0 Instruction
Form 46
Other-Redline
Liver Cholangiocarcinoma (CCA) Initial MELD/PELD Score Exception Form New 60 26 0 Form 111
Instruction
Liver Cholangiocarcinoma (CCA) MELD/PELD Score Exception Extension Form New 48 15 0 Instruction
Form 112
Liver Cystic Fibrosis (CF) Initial MELD/PELD Score Exception and Extension Form New 14 5 0 Form 113
Instruction
Liver Familial Amyloid Polyneuropathy (FAP) Initial MELD/PELD Score Exception Form New 6 2 0 Instruction
Form 114
Liver Familial Amyloid Polyneuropathy (FAP) MELD/PELD Score Exception Extension Form New 7 2 0 Form 115
Instruction
Liver Hepatic Artery Thrombosis (HAT) Initial MELD/PELD Score Exception and Extension Form New 98 34 0 Instruction
Form 116
Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form New 3309 1555 0 Form 117
Instruction
Liver Hepatocellular Carcinoma (HCC) MELD/PELD Score Exception Extension Form New 4716 1651 0 Instruction
Form 118
Liver Hepatopulmonary Syndrome (HPS) Initial MELD/PELD Score Exception Form New 197 63 0 Form 119
Instruction
Liver Hepatopulmonary Syndrome (HPS) MELD/PELD Score Exception Extension Form New 141 35 0 Instruction
Form 120
Liver Metabolic Disease Initial MELD/PELD Score Exception and Extension Form New 109 31 0 Form 121
Instruction
Liver Other Diagnosis Initial MELD/PELD Score Exception and Extension Form New 1708 598 0 Form 125
Instruction
Liver Portopulmonary Hypertension Initial MELD/PELD Score Exception Form New 72 30 0 Instruction
Form 122
Liver Portopulmonary Hypertension MELD/PELD Score Exception Extension Form New 51 17 0 Form 123
Instruction
Liver Post Transplant Malignancy (PTM) Form Modified 3012 2410 0 Instruction
Form 29
Liver Primary Hyperoxaluria Initial MELD/PELD Score Exception and Extension Form New 18 6 0 Instruction
Form 124
Liver Recipient Explant Pathology Form Modified 1018 611 0 Instruction
Form 28
Other-Redline
Liver Transplant Candidate Registration (TCR) Modified 14681 11745 0 Instruction
Form 24
Other-Redline
Liver Transplant Recipient Follow Up 6 Month -5 Year (TRF) Modified 48926 48926 0 Instruction
Form 26
Other-Redline
Liver Transplant Recipient Follow Up Post 5 Year (TRF) Modified 60714 30357 0 Instruction
Form 27
Other-Redline
Liver Transplant Recipient Registration (TRR) Modified 10661 12793 0 Instruction
Form 25
Other-Redline
Living Donor Event Modified 31 17 0 Instruction
Form 59
Living Donor Feedback Form New 7810 1015 0 Form 149
Instruction
Living Donor Follow-up (LDF) Modified 19636 29847 0 Form 3
Other-Redline
Instruction
Living Donor Registration (LDR) Modified 6918 15150 0 Instruction
Form 2
Other-Redline
Lung - Post Transplant Malignancy (PTM) Form Modified 1361 544 0 Instruction
Form 17
Lung Transplant Candidate Registration (TCR) Modified 3357 3189 0 Instruction
Form 12
Other-Redline
Lung Transplant Recipient Follow Up 1-5 Year (TRF) Modified 10035 11039 0 Instruction
Form 15
Other-Redline
Lung Transplant Recipient Follow Up 6 Month (TRF) Modified 2661 1331 0 Instruction
Form 14
Other-Redline
Lung Transplant Recipient Follow Up Post 5 Year (TRF) Modified 10959 6575 0 Instruction
Form 16
Other-Redline
Lung Transplant Recipient Registration (TRR) Modified 3023 3446 0 Instruction
Form 13
Other-Redline
Non-US Transplants Reporting Form New 0 0 0 Form 151
Instruction
OPO Notification Limit Administration Modified 533 91 0 Instruction
Form 64
OPTN Pancreas Waiting Time Reinstatement Form New 4 1 0 Instruction
Form 104
OPTN Renal Waiting Time Reinstatement Form New 276 75 0 Form 103
Instruction
OPTN Waiting Time Modification Form New 14731 3241 0 Instruction
Form 102
OPTN Waiting Time Transfer Form New 1374 316 0 Form 101
Instruction
Organ Export Verification Form New 26 1 0 Form 100
Instruction
Organ Labeling and Packaging System Modified 16703 3007 0 Instruction
Form 53
Organ Tracking and Validating System Modified 6189 495 0 Instruction
Form 54
Pancreas Post Transplant Malignancy (PTM) Form Modified 93 56 0 Instruction
Form 44
Pancreas Transplant Candidate Registration (TCR) Modified 323 194 0 Instruction
Form 40
Other-Redline
Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF) Modified 621 311 0 Instruction
Form 42
Other-Redline
Pancreas Transplant Recipient Follow Up Post 5 Year (TRF) Modified 2105 1053 0 Instruction
Form 43
Other-redline
Pancreas Transplant Recipient Registration (TRR) Modified 103 124 0 Instruction
Form 41
Other-Redline
Pediatric Heart Candidate Listing Registration New 734 426 0 Instruction
Form 84
Pediatric Heart and HeartLung Status 1A Extension and Appeal Justification Forms New 3495 1643 0 Form 127
Instruction
Pediatric Heart and HeartLung Status 1A Initial Justification Form New 1028 535 0 Instruction
Form 126
Pediatric Heart and HeartLung Status 1B Initial Justification Form New 468 197 0 Instruction
Form 128
Pediatric HeartLung Candidate Listing Registration New 4 4 0 Instruction
Form 86
Pediatric Intestine Candidate Listing Registration New 46 20 0 Form 82
Instruction
Pediatric Kidney Candidate Listing Registration New 1178 554 0 Form 72
Instruction
Pediatric Kidney Pancreas Candidate Listing Registration New 2 1 0 Form 74
Instruction
Pediatric Liver Candidate Listing Registration New 705 282 0 Form 80
Instruction
Pediatric Liver Status 1A Initial Justification and Extension Form New 131 75 0 Form 109
Instruction
Pediatric Liver Status 1B Initial Justification and Extension Form New 320 150 0 Instruction
Form 110
Pediatric Lung Candidate Listing Registration New 38 32 0 Instruction
Form 88
Pediatric Lung Priority 1 Status Justification Form New 52 17 0 Form 147
Instruction
Pediatric Pancreas Candidate Listing Registration New 34 13 0 Form 76
Instruction
Pediatric Pancreas Islet Listing Registration New 0 0 0 Form 78
Instruction
Potential Disease Transmission Report Modified 621 789 0 Instruction
Form 61
Potential Transplant Recipient Modified 1829393 91470 0 Instruction
Form 65
Other-Redline
Prior Living Donor Priority New 57 15 0 Instruction
Form 106
Recipient Histocompatibility Form Modified 42378 16951 0 Instruction
Form 5
Other-Redline
Request to Unlock Form Modified 77204 1544 0 Instruction
Form 62
Review Board Voter Form New 5570 1281 0 Instruction
Form 148
Safety Situation Modified 411 99 0 Instruction
Form 60
Other-Redline
Transplant Center Contact Management Modified 200409 12025 0 Instruction
Form 70
VCA Abdominal Wall Candidate Listing Registration New 3 1 0 Instruction
Form 90
VCA External Male Genitalia Candidate Listing Registration New 0 0 0 Form 91
Instruction
VCA Head and Neck Candidate Listing Registration New 5 2 0 Form 92
Instruction
VCA Lower Limb Candidate Listing Registration New 0 0 0 Instruction
Form 93
VCA Musculoskeletal Composite Graft Segment Candidate Listing Registration New 0 0 0 Form 94
Instruction
VCA Other Genitourinary Organ Candidate Listing Registration New 0 0 0 Instruction
Form 95
VCA Spleen Candidate Listing Registration New 0 0 0 Form 96
Instruction
VCA Transplant Candidate Registration (TCR) Modified 23 9 0 Instruction
Form 50
Other-Redline
VCA Transplant Recipient Follow Up (TRF) Modified 53 69 0 Instruction
Form 52
Other-redline
VCA Transplant Recipient Registration (TRR) Modified 9 12 0 Instruction
Form 51
Other-Redline
VCA Upper Limb Candidate Listing Registration New 3 1 0 Instruction
Form 97
VCA Uterus Candidate Listing Registration New 12 4 0 Form 98
Instruction
VCA Vascularized Gland Candidate Listing Registration New 0 0 0 Instruction
Form 99
Total burden requested under this ICR: 3184246 851578 0  
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