View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0906-0110
ICR Reference No:
202508-0906-005
Status:
Active
Previous ICR Reference No:
202306-0915-003
Agency/Subagency:
HHS/HRSA
Agency Tracking No:
Title:
Data System for Organ Procurement and Transplantation Network
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
08/25/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/25/2025
Terms of Clearance:
Prior to the next revision or extension of this package the agency will implement batch reporting to automate data collection and complete a deduplication review to ensure that redundant data elements are no longer collected. If logistical obstacles prevent implementation of either of these improvements, then a detailed explanation of steps taken and obstacles encountered will be provided in the package.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2028
36 Months From Approved
Responses
3,184,246
0
2,352,737
Time Burden (Hours)
851,578
0
647,633
Cost Burden (Dollars)
0
0
0
Abstract:
Section 372 of the Public Health Service Act requires that the Secretary of Health and Human Services, by award, provide for the establishment and operation of the Organ Procurement and Transplantation Network (OPTN), which, under oversight of the HRSA, operates the U.S. Organ Procurement and Transplantation system. Significant changes to the collection include: 1) Adding data collection forms for candidates listed in the OPTN organ transplant waiting list to the existing OMB-approved information collection. These forms allow a transplant center to add, change, or remove candidates from the OPTN waiting list after a transplant center completes the patient evaluation. These forms contain information that the OPTN electronic organ matching system uses to match potential organ recipients with available deceased donor organs. There are 83 new data collection forms: candidate listing registration forms of all organs, candidate status justification forms of all applicable organs, Model for End-Stage Liver Disease or Pediatric End-Stage Liver Disease score exception and extension forms, and other forms. Additional revisions to existing OPTN data collection forms were made based on the OPTN Board of Directors (BOD)-approved changes to improve organ matching, allocation, and OPTN policy compliance; 2) Adding OPTN Board of Directors-approved revisions to existing data collection forms to improve organ matching, allocation, and OPTN policy compliance.
Authorizing Statute(s):
US Code:
42 USC 274(b)(2)(I), Sec 372(b)(2)(I)
Name of Law: PHS Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
89 FR 87380
11/01/2024
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 27037
06/25/2025
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
153
IC Title
Form No.
Form Name
Adult Heart Candidate Listing Registration
83
Adult Heart Candidate Listing Registration
Adult Heart and HeartLung Status 1 Criteria 1 Extension Justification Form Medical Urgency Data
133
Adult Heart and HeartLung Status 1 Criteria 1 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 1 Exception Extension Justification Form Medical Urgency Data
132
Adult Heart and HeartLung Status 1 Exception Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 1 Initial Justification Form Medical Urgency Data
131
Adult Heart and HeartLung Status 1 Initial Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 1-6 Justification Form Demographic Data
129
Adult Heart and HeartLung Status 1-6 Justification Form Demographic Data
Adult Heart and HeartLung Status 1-6 Justification Form Risk Stratification Data
130
Adult Heart and HeartLung Status 1-6 Justification Form Risk Stratification Data
Adult Heart and HeartLung Status 2 Criteria 1 Extension Justification Form Medical Urgency Data
136
Adult Heart and HeartLung Status 2 Criteria 1 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 2 Criteria 4 Extension Justification Form Medical Urgency Data
137
Adult Heart and HeartLung Status 2 Criteria 4 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 2 Criteria 5 Extension Justification Form Medical Urgency Data
138
Adult Heart and HeartLung Status 2 Criteria 5 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 2 Exception Extension Justification Form Medical Urgency Data
135
Adult Heart and HeartLung Status 2 Exception Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 2 Initial Justification Form Medical Urgency Data
134
Adult Heart and HeartLung Status 2 Initial Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 3 Criteria 2 Extension Justification Form Medical Urgency Data
141
Adult Heart and HeartLung Status 3 Criteria 2 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 3 Criteria 5 Extension Justification Form Medical Urgency Data
142
Adult Heart and HeartLung Status 3 Criteria 5 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 3 Exception Extension Justification Form Medical Urgency Data
140
Adult Heart and HeartLung Status 3 Exception Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 3 Initial Justification Form Medical Urgency Data
139
Adult Heart and HeartLung Status 3 Initial Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 4 Criteria 2 Extension Justification Form Medical Urgency Data
145
Adult Heart and HeartLung Status 4 Criteria 2 Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 4 Exception Extension Justification Form Medical Urgency Data
144
Adult Heart and HeartLung Status 4 Exception Extension Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 4 Initial Justification Form Medical Urgency Data
143
Adult Heart and HeartLung Status 4 Initial Justification Form Medical Urgency Data
Adult HeartLung Candidate Listing Registration
85
Adult HeartLung Candidate Listing Registration
Adult Intestine Candidate Listing Registration
81
Adult Intestine Candidate Listing Registration
Adult Kidney Candidate Listing Registration
71
Adult Kidney Candidate Listing Registration
Adult Kidney Pancreas Candidate Listing Registration
73
Adult Kidney Pancreas Candidate Listing Registration
Adult Liver Candidate Listing Registration
79
Adult Liver Candidate Listing Registration
Adult Liver Status 1A Initial Justification and Extension Form
108
Adult Liver Status 1A Initial Justification and Extension Form
Adult Lung Candidate Listing Registration
87
Adult Lung Candidate Listing Registration
Adult Pancreas Candidate Listing Registration
75
Adult Pancreas Candidate Listing Registration
Adult Pancreas Islet Listing Registration
77
Adult Pancreas Islet Listing Registration
Adult and Pediatric Lung and HeartLung Goal Exception Form
146
Adult and Pediatric Lung and HeartLung Goal Exception Form
Candidate Registration Listing Removal
89
Candidate Registration Listing Removal
Death Notification Registration
66
Death Notification Registration
Deceased Donor Death Referral
67
Deceased Donor Death Referral
Deceased Donor Registration (DDR)
1
Deceased Donor Registration (DDR)
Discrepant HLA Typings Reporting Form
152
Non-US Transplants Reporting Form
Disease Transmission Event
58
Disease Transmission Event_Form.xlsx
Donor Histocompatibility Form
4
Donor Histocompatibility_Form.xlsx
Donor Hospital Registration
68
Donor Hospital Registration
Donor Organ Disposition
69
Donor Organ Disposition
Extra Vessels Reporting Form
150
Extra Vessels Reporting Form
Heart Post-Transplant Malignancy Form
11
Heart Post Transplant Malignancy_Form.xlsx
Heart Transplant Candidate Registration (TCR)
6
Heart Transplant Candidate Registration_Form_clean.xlsx
Heart Transplant Recipient Follow Up (6 months)
8
Heart Transplant Recipient Follow Up 6 Month_Form.xlsx
Heart Transplant Recipient Follow Up 1-5 Year
9
Heart Transplant Recipient Follow Up 1_5 Year _Form_Clean.xlsx
Heart Transplant Recipient Follow Up Post 5 Year
10
Heart Transplant Recipient Follow Up Post 5 Year_Form_Clean.xlsx
Heart Transplant Recipient Registration (TRR)
7
Heart Transplant Recipient Registration_Form_clean.xlsx
Heart/Lung Post Transplant Malignancy (PTM) Form
23
HeartLung Post Transplant Malignancy_Form.xlsx
Heart/Lung Recipient Registration
19
Heart/Lung Transplant Recipient Registration_Form_clean.xlsx
Heart/Lung Transplant Candidate Registration (TCR)
18
Heart/Lung Transplant Candidate Registration_Form_clean.xlsx
Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)
21
Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
Heart/Lung Transplant Recipient Follow Up 6 Month (TRF)
20
Heart/Lung Transplant Recipient Follow Up 6 Month_Form.xlsx
Heart/Lung Transplant Recipient Follow Up Post 5 Year (TRF)
22
Heart/Lung Transplant Recipient Follow Up Post 5 Year_Form.xlsx
Initial Donor Registration
63
Initial Donor Registration
Interim Event Reporting Form
153
Interim Event Reporting Form
Intestinal Waiting Time Reinstatement Form
105
Intestinal Waiting Time Reinstatement Form
Intestine Post Transplant Malignancy (PTM) Form
34
Intestine Post Transplant Malignancy_Form.xlsx
Intestine Transplant Candidate Registration (TCR)
30
Intestine Transplant Candidate Registration_Form_clean.xlsx
Intestine Transplant Recipient Follow Up 6 Month -5 Year (TRF)
32
Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Intestine Transplant Recipient Follow Up Post 5 Year (TRF)
33
Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Intestine Transplant Recipient Registration (TRR)
31
Intestine Transplant Recipient Registration_Form_clean.xlsx
Kidney Minimum Acceptance Criteria
107
Kidney Minimum Acceptance Criteria
Kidney Paired Donation Candidate Registration
55
Kidney Paired Donation Candidate Registration_Form_clean.xlsx
Kidney Paired Donation Donor Registration
56
Kidney Paired Donation Donor Registration_Form_clean.xlsx
Kidney Paired Donation Match Offer Management
57
Kidney Paired Donation Match Offer Management_Form.xlsx
Kidney Post Transplant Malignancy (PTM) Form
39
Kidney Post Transplant Malignancy_Form.xlsx
Kidney Transplant Candidate Registration (TCR)
35
Kidney Transplant Candidate Registration_Form_clean.xlsx
Kidney Transplant Recipient Follow Up 6 Month -5 Year (TRF)
37
Kidney Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Kidney Transplant Recipient Follow Up Post 5 Year (TRF)
38
Kidney Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Kidney Transplant Recipient Registration (TRR)
36
Kidney Transplant Recipient Registration_Form_clean.xlsx
Kidney/Pancreas Post Transplant Malignancy (PTM) Form
49
Kidney/Pancreas Post Transplant Malignancy_Form.xlsx
Kidney/Pancreas Transplant Candidate Registration (TCR)
45
Kidney/Pancreas Transplant Candidate Registration_Form_clean.xlsx
Kidney/Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)
47
Kidney/Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)
48
Kidney/Pancreas Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Kidney/Pancreas Transplant Recipient Registration (TRR)
46
Kidney/Pancreas Transplant Recipient Registration_Form_clean.xlsx
Liver Cholangiocarcinoma (CCA) Initial MELD/PELD Score Exception Form
111
Liver Cholangiocarcinoma (CCA) Initial MELD/PELD Score Exception Form
Liver Cholangiocarcinoma (CCA) MELD/PELD Score Exception Extension Form
112
Liver Cholangiocarcinoma (CCA) MELD/PELD Score Exception Extension Form
Liver Cystic Fibrosis (CF) Initial MELD/PELD Score Exception and Extension Form
113
Liver Cystic Fibrosis (CF) Initial MELD/PELD Score Exception and Extension Form
Liver Familial Amyloid Polyneuropathy (FAP) Initial MELD/PELD Score Exception Form
114
Liver Familial Amyloid Polyneuropathy (FAP) Initial MELD/PELD Score Exception Form
Liver Familial Amyloid Polyneuropathy (FAP) MELD/PELD Score Exception Extension Form
115
Liver Familial Amyloid Polyneuropathy (FAP) MELD/PELD Score Exception Extension Form
Liver Hepatic Artery Thrombosis (HAT) Initial MELD/PELD Score Exception and Extension Form
116
Liver Hepatic Artery Thrombosis (HAT) Initial MELD/PELD Score Exception and Extension Form
Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form
117
Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form
Liver Hepatocellular Carcinoma (HCC) MELD/PELD Score Exception Extension Form
118
Liver Hepatocellular Carcinoma (HCC) MELD/PELD Score Exception Extension Form
Liver Hepatopulmonary Syndrome (HPS) Initial MELD/PELD Score Exception Form
119
Liver Hepatopulmonary Syndrome (HPS) Initial MELD/PELD Score Exception Form
Liver Hepatopulmonary Syndrome (HPS) MELD/PELD Score Exception Extension Form
120
Liver Hepatopulmonary Syndrome (HPS) MELD/PELD Score Exception Extension Form
Liver Metabolic Disease Initial MELD/PELD Score Exception and Extension Form
121
Liver Metabolic Disease Initial MELD/PELD Score Exception and Extension Form
Liver Other Diagnosis Initial MELD/PELD Score Exception and Extension Form
125
Liver Other Diagnosis Initial MELD/PELD Score Exception and Extension Form
Liver Portopulmonary Hypertension Initial MELD/PELD Score Exception Form
122
Liver Portopulmonary Hypertension Initial MELD/PELD Score Exception Form
Liver Portopulmonary Hypertension MELD/PELD Score Exception Extension Form
123
Liver Portopulmonary Hypertension MELD/PELD Score Exception Extension Form
Liver Post Transplant Malignancy (PTM) Form
29
Liver Post Transplant Malignancy_Form.xlsx
Liver Primary Hyperoxaluria Initial MELD/PELD Score Exception and Extension Form
124
Liver Primary Hyperoxaluria Initial MELD/PELD Score Exception and Extension Form
Liver Recipient Explant Pathology Form
28
Liver Explant Pathology Form.xlsx
Liver Transplant Candidate Registration (TCR)
24
Liver Transplant Candidate Registration_Form.xlsx
Liver Transplant Recipient Follow Up 6 Month -5 Year (TRF)
26
Liver Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Liver Transplant Recipient Follow Up Post 5 Year (TRF)
27
Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx
Liver Transplant Recipient Registration (TRR)
25
Liver Transplant Recipient Registration_Form_clean.xlsx
Living Donor Event
59
Living Donor Event_Form.xlsx
Living Donor Feedback Form
149
Living Donor Feedback Form
Living Donor Follow-up (LDF)
3
Living Donor Follow-Up Form
Living Donor Registration (LDR)
2
Living Donor Registration Form
Lung - Post Transplant Malignancy (PTM) Form
17
Lung Post Transplant Malignancy_Form.xlsx
Lung Transplant Candidate Registration (TCR)
12
Lung Transplant Candidate Registration_Form
Lung Transplant Recipient Follow Up 1-5 Year (TRF)
15
Lung Transplant Recipient Follow Up 1_5 Year_Form
Lung Transplant Recipient Follow Up 6 Month (TRF)
14
Lung Transplant Recipient Follow Up 6 Month_Form.xlsx
Lung Transplant Recipient Follow Up Post 5 Year (TRF)
16
Lung Transplant Recipient Follow Up Post 5 Year_Form
Lung Transplant Recipient Registration (TRR)
13
Lung Transplant Recipient Registration_Form_clean.xlsx
Non-US Transplants Reporting Form
151
Non-US Transplants Reporting Form
OPO Notification Limit Administration
64
OPO Notification Limit Administration
OPTN Pancreas Waiting Time Reinstatement Form
104
OPTN Pancreas Waiting Time Reinstatement Form
OPTN Renal Waiting Time Reinstatement Form
103
Renal Waiting Time Reinstatement Form
OPTN Waiting Time Modification Form
102
OPTN Waiting Time Modification Form
OPTN Waiting Time Transfer Form
101
OPTN Waiting Time Transfer Form
Organ Export Verification Form
100
Organ Export Verification Form
Organ Labeling and Packaging System
53
Organ Labeling and Packaging_Form.xlsx
Organ Tracking and Validating System
54
Organ Tracking and Validating_Form.xlsx
Pancreas Post Transplant Malignancy (PTM) Form
44
Pancreas Post Transplant Malignancy_Form.xlsx
Pancreas Transplant Candidate Registration (TCR)
40
Pancreas Transplant Candidate Registration_Form_clean.xlsx
Pancreas Transplant Recipient Follow Up 6 Month -5 Year (TRF)
42
Pancreas Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx
Pancreas Transplant Recipient Follow Up Post 5 Year (TRF)
43
Pancreas Transplant Recipient Follow Up Post 5 Year_ Form_clean.xlsx
Pancreas Transplant Recipient Registration (TRR)
41
Pancreas Transplant Recipient Registration_Form_clean.xlsx
Pediatric Heart Candidate Listing Registration
84
Pediatric Heart Candidate Listing Registration
Pediatric Heart and HeartLung Status 1A Extension and Appeal Justification Forms
127
Pediatric Heart and HeartLung Status 1A Extension and Appeal Justification Forms
Pediatric Heart and HeartLung Status 1A Initial Justification Form
126
Pediatric Heart and HeartLung Status 1A Initial Justification Form
Pediatric Heart and HeartLung Status 1B Initial Justification Form
128
Pediatric Heart and HeartLung Status 1B Initial Justification Form
Pediatric HeartLung Candidate Listing Registration
86
Pediatric HeartLung Candidate Listing Registration
Pediatric Intestine Candidate Listing Registration
82
Pediatric Intestine Candidate Listing Registration
Pediatric Kidney Candidate Listing Registration
72
Pediatric Kidney Candidate Listing Registration Form
Pediatric Kidney Pancreas Candidate Listing Registration
74
Pediatric Kidney Pancreas Candidate Listing Registration
Pediatric Liver Candidate Listing Registration
80
Pediatric Liver Candidate Listing Registration
Pediatric Liver Status 1A Initial Justification and Extension Form
109
Pediatric Liver Status 1A Initial Justification and Extension Form
Pediatric Liver Status 1B Initial Justification and Extension Form
110
Pediatric Liver Status 1B Initial Justification and Extension Form
Pediatric Lung Candidate Listing Registration
88
Pediatric Lung Candidate Listing Registration
Pediatric Lung Priority 1 Status Justification Form
147
Pediatric Lung Priority 1 Status Justification Form
Pediatric Pancreas Candidate Listing Registration
76
Pediatric Pancreas Candidate Listing Registration
Pediatric Pancreas Islet Listing Registration
78
Pediatric Pancreas Islet Listing Registration
Potential Disease Transmission Report
61
Potential Disease Transmission Report_Form.xlsx
Potential Transplant Recipient
65
Potential Transplant Recipient
Prior Living Donor Priority
106
Prior Living Donor Priority
Recipient Histocompatibility Form
5
Recipient Histocompatibility_Form._Clean.xlsx
Request to Unlock Form
62
Request to Unlock Form_Form.xlsx
Review Board Voter Form
148
Review Board Voter Form
Safety Situation
60
Safety Situation_Form.xlsx
Transplant Center Contact Management
70
Transplant Center Contact Management
VCA Abdominal Wall Candidate Listing Registration
90
VCA Abdominal Wall Candidate Listing Registration
VCA External Male Genitalia Candidate Listing Registration
91
VCA Head and Neck Candidate Listing Registration
VCA Head and Neck Candidate Listing Registration
92
VCA Head and Neck Candidate Listing Registration
VCA Lower Limb Candidate Listing Registration
93
VCA Lower Limb Candidate Listing Registration
VCA Musculoskeletal Composite Graft Segment Candidate Listing Registration
94
VCA Musculoskeletal Composite Graft Segment Candidate Listing Registration
VCA Other Genitourinary Organ Candidate Listing Registration
95
VCA Other Genitourinary Organ Candidate Listing Registration
VCA Spleen Candidate Listing Registration
96
VCA Spleen Candidate Listing Registration
VCA Transplant Candidate Registration (TCR)
50
VCA Transplant Candidate Registration_Form.xlsx
VCA Transplant Recipient Follow Up (TRF)
52
VCA Transplant Recipient Follow Up_Form_clean.xlsx
VCA Transplant Recipient Registration (TRR)
51
VCA Transplant Recipient Registration_Form_clean.xlsx
VCA Upper Limb Candidate Listing Registration
97
VCA Upper Limb Candidate Listing Registration
VCA Uterus Candidate Listing Registration
98
VCA Uterus Candidate Listing Registration
VCA Vascularized Gland Candidate Listing Registration
99
VCA Vascularized Gland Candidate Listing Registration
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
3,184,246
2,352,737
0
831,509
0
0
Annual Time Burden (Hours)
851,578
647,633
0
203,945
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The estimated burden hours for this collection increased by 203,945 hours from the currently approved ICR package. This increase included 96,156 hours due to the addition of 83 new data collection forms for the OPTN waiting list and 107,789 hours due to OPTN BOD-approved data collection changes to existing forms and changes in the number of respondents. Any burden reductions to existing forms are due to adjustments in the average burden per response based on stakeholder consultation.
Annual Cost to Federal Government:
$600,530
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Laura Cooper 301 443-2126 lcooper@hrsa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
07/02/2025
An official website of the United States government
The .gov means it's official.
The site is secure.
