Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Additional Surgeon and Physician Request Form Modified 311 261 0 Form and Instruction 19 Additional Surgeon and Physician Request Form
HOPE Act Variance Request Form Modified 2 1 0 Form and Instruction 20 HOPE Act Variance Request Form
Information Security Contact Management Form New 675 128 0 Form and Instruction 23 Information Security Contact Management Form
Kidney Paired Donation Pilot Program (KPDPP) contact update Form Modified 29 16 0 Form and Instruction 21 Kidney Paired Donation Pilot Program (KPDPP) contact update form
OPTN Business Membership Application Modified 9 14 0 Form and Instruction 14 OPTN Business Membership Application
OPTN Individual Membership Application Modified 10 15 0 Form and Instruction 15 OPTN Individual Membership Application
OPTN Medical Scientific Membership Application Modified 2 3 0 Form and Instruction 12 OPTN Medical/Scientific Membership Application
OPTN Membership Application Islet Transplant Program Modified 2 16 0 Form and Instruction 7 OPTN Membership Application for Islet Transplant Programs
OPTN Membership Application Surgeon or Physician Log New 0 0 0 Form and Instruction 22 OPTN Membership Application Surgeon or Physician Log
OPTN Membership Application for Heart Transplant Program Modified 39 656 0 Form and Instruction 5 OPTN Membership Application for Heart Transplant Programs
OPTN Membership Application for Histocompatibility Labs Modified 31 115 0 Form and Instruction 10 OPTN Membership Application for Histocompatibility Laboratories
OPTN Membership Application for Intestine Transplant Programs Modified 4 44 0 Form and Instruction 9 OPTN Membership Application for Intestine Transplant Programs
OPTN Membership Application for Kidney Transplant Programs Modified 80 548 0 Form and Instruction 2 OPTN Membership Application for Kidney Transplant Programs
OPTN Membership Application for Liver Transplant Progrms Modified 67 388 0 Form and Instruction 3 OPTN Membership Application for Liver Transplant Programs
OPTN Membership Application for Lung Transplant Program Modified 17 98 0 Form and Instruction 6 OPTN Membership Application for Lung Transplant Programs
OPTN Membership Application for OPOs Modified 10 183 0 Form and Instruction 11 OPTN Membership Application for OPOs
OPTN Membership Application for Pancreas Transplant Programs Modified 30 174 0 Form and Instruction 4 OPTN Membership Application for Pancreas Transplant Programs
OPTN Membership Application for Transplant Hospitals and Programs Modified 35 426 0 Form and Instruction 1 OPTN Membership Application for Transplant Hospitals and Programs
OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs Modified 13 309 0 Form and Instruction 8 OPTN Membership Application for Vascularized Composite Allograft (VCA) Transplant Programs
OPTN Public Organization Membership Application Modified 4 8 0 Form and Instruction 13 OPTN Public Organization Membership Application
OPTN Representative Form Modified 135 58 0 Form and Instruction 16 OPTN Representative Form
Primary Data Coordinator Form Modified 93 40 0 Form and Instruction 17 Primary Data Coordinator Form
Primary Program Administrator Form Modified 101 45 0 Form and Instruction 18 Primary Program Administrator Form
Total burden requested under this ICR: 1699 3546 0  
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