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View ICR - Agency Submission
COMMENT
Time Remaining
Days
HR
Min
Sec
OMB Control No:
0906-0110
ICR Reference No:
202610-0906-001
Status:
Received in OIRA
Previous ICR Reference No:
202508-0906-005
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
Date Submitted to OIRA:
10/14/2026
Requested
Previously Approved
Expiration Date
36 Months From Approved
08/31/2028
Responses
3,085,442
3,184,246
Time Burden (Hours)
903,603
851,578
Cost Burden (Dollars)
0
0
Abstract:
Section 372(a) of the Public Health Service (PHS) Act requires the Secretary of Health and Human Services to provide for the establishment and operation of the OPTN. On behalf of HRSA, the OPTN oversees the United States (U.S.) organ procurement and transplantation system. Among its statutory responsibilities, the OPTN maintains the national waiting list of individuals awaiting organ transplantation, operates the computerized system that matches donor organs with transplant candidates, and maintains a 24-hour system to facilitate organ matching and placement. In accordance with Section 372(b)(2)(I) of the PHS Act (42 U.S.C. ยง 274(b)(2)(I)), the OPTN must also collect, analyze, and publish data concerning organ procurement and transplantation. The Health Resources and Services Administration (HRSA) seeks OMB approval for revisions to the Data System for the Organ Procurement and Transplantation Network (OPTN) information collection and the associated forms listed in Section 12. The proposed revisions include updates to existing data collection forms approved by the OPTN Board of Directors (BOD) to improve organ matching, organ allocation, and compliance with OPTN policies. This request also adds two new forms to the information collection: the Patient Safety Contact Management Form and the Patient Transfer Form (Forms 151 and 152 in the burden table in Section 12). The Patient Safety Contact Management Form enables OPTN members to identify their organization's primary and secondary patient safety contacts. The Patient Transfer Form enables transplant centers to document and facilitate the transfer of patients to another transplant center following transplantation and during the annual post-transplant follow-up period.
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:
91 FR 27964
05/15/2026
30-day Notice:
Federal Register Citation:
Citation Date:
91 FR 64665
10/09/2026
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
152
IC Title
Form No.
Form Name
Adult Heart Candidate Listing Registration
80
Adult Heart Candidate Listing Registration
Adult Heart and HeartLung Status 1 Criteria 1 Extension Justification Form Medical Urgency Data
130
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
129
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
128
Adult Heart and HeartLung Status 1 Initial Justification Form Medical Urgency Data
Adult Heart and HeartLung Status 1-6 Justification Form Demographic Data
126
Adult Heart and HeartLung Status 1-6 Justification Form Demographic Data
Adult Heart and HeartLung Status 1-6 Justification Form Risk Stratification Data
127
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
133
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
134
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
135
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
132
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
131
Adult Heart and HeartLung Status 2 Initial Justification Form Medical Urgency Data_Form_clean
Adult Heart and HeartLung Status 3 Criteria 2 Extension Justification Form Medical Urgency Data
138
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
139
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
137
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
136
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
142
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
141
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
140
Adult Heart and HeartLung Status 4 Initial Justification Form Medical Urgency Data
Adult HeartLung Candidate Listing Registration
82
Adult HeartLung Candidate Listing Registration
Adult Intestine Candidate Listing Registration
78
Adult Intestine Candidate Listing Registration
Adult Kidney Candidate Listing Registration
68
Adult Kidney Candidate Listing Registration
Adult Kidney Pancreas Candidate Listing Registration
70
Adult Kidney Pancreas Candidate Listing Registration
Adult Liver Candidate Listing Registration
76
Adult Liver Candidate Listing Registration
Adult Liver Status 1A Initial Justification and Extension Form
105
Adult Liver Status 1A Initial Justification and Extension Form
Adult Lung Candidate Listing Registration
84
Adult Lung Candidate Listing Registration_Form_clean
Adult Pancreas Candidate Listing Registration
72
Adult Pancreas Candidate Listing Registration
Adult Pancreas Islet Listing Registration
74
Adult Pancreas Islet Listing Registration
Adult and Pediatric Lung and HeartLung Goal Exception Form
143
Adult and Pediatric Lung and HeartLung Goal Exception Form
Candidate Registration Listing Removal
86
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 Form
Discrepant HLA Typings Reporting Form
149
Discrepant HLA Typings Reporting Form
Disease Transmission Event
57
Disease Transmission Event_Form.xlsx
Donor Histocompatibility Form
4
Donor Histocompatibility_Form.xlsx
Donor Hospital Registration
65
Donor Hospital Registration
Donor Organ Disposition
66
Donor Organ Disposition
Extra Vessels Reporting Form
147
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
62
Initial Donor Registration
Interim Event Reporting Form
150
Interim Event Reporting Form
Intestinal Waiting Time Reinstatement Form
102
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
104
Kidney Minimum Acceptance Criteria
Kidney Paired Donation Candidate Registration
54
Kidney Paired Donation Candidate Registration_Form_clean.xlsx
Kidney Paired Donation Donor Registration
55
Kidney Paired Donation Donor Registration_Form_clean.xlsx
Kidney Paired Donation Match Offer Management
56
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
108
Liver Cholangiocarcinoma (CCA) Initial MELD/PELD Score Exception Form
Liver Cholangiocarcinoma (CCA) MELD/PELD Score Exception Extension Form
109
Liver Cholangiocarcinoma (CCA) MELD/PELD Score Exception Extension Form
Liver Cystic Fibrosis (CF) Initial MELD/PELD Score Exception and Extension Form
110
Liver Cystic Fibrosis (CF) Initial MELD/PELD Score Exception and Extension Form
Liver Familial Amyloid Polyneuropathy (FAP) Initial MELD/PELD Score Exception Form
111
Liver Familial Amyloid Polyneuropathy (FAP) Initial MELD/PELD Score Exception Form
Liver Familial Amyloid Polyneuropathy (FAP) MELD/PELD Score Exception Extension Form
112
Liver Familial Amyloid Polyneuropathy (FAP) MELD/PELD Score Exception Extension Form
Liver Hepatic Artery Thrombosis (HAT) Initial MELD/PELD Score Exception and Extension Form
113
Liver Hepatic Artery Thrombosis (HAT) Initial MELD/PELD Score Exception and Extension Form
Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form
114
Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form
Liver Hepatocellular Carcinoma (HCC) MELD/PELD Score Exception Extension Form
115
Liver Hepatocellular Carcinoma (HCC) MELD/PELD Score Exception Extension Form
Liver Hepatopulmonary Syndrome (HPS) Initial MELD/PELD Score Exception Form
116
Liver Hepatopulmonary Syndrome (HPS) Initial MELD/PELD Score Exception Form
Liver Hepatopulmonary Syndrome (HPS) MELD/PELD Score Exception Extension Form
117
Liver Hepatopulmonary Syndrome (HPS) MELD/PELD Score Exception Extension Form
Liver Metabolic Disease Initial MELD/PELD Score Exception and Extension Form
118
Liver Metabolic Disease Initial MELD/PELD Score Exception and Extension Form
Liver Other Diagnosis Initial MELD/PELD Score Exception and Extension Form
122
Liver Other Diagnosis Initial MELD/PELD Score Exception and Extension Form
Liver Portopulmonary Hypertension Initial MELD/PELD Score Exception Form
119
Liver Portopulmonary Hypertension Initial MELD/PELD Score Exception Form
Liver Portopulmonary Hypertension MELD/PELD Score Exception Extension Form
120
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
121
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
58
Living Donor Event_Form.xlsx
Living Donor Feedback Form
146
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
148
Non-US Transplants Reporting Form
OPO Notification Limit Administration
63
OPO Notification Limit Administration
OPTN Pancreas Waiting Time Reinstatement Form
101
OPTN Pancreas Waiting Time Reinstatement Form
OPTN Renal Waiting Time Reinstatement Form
100
Renal Waiting Time Reinstatement Form
OPTN Waiting Time Modification Form
99
OPTN Waiting Time Modification Form
OPTN Waiting Time Transfer Form
98
OPTN Waiting Time Transfer Form
Organ Export Verification Form
97
Organ Export Verification Form
Organ Labeling and Packaging System
52
Organ Labeling and Packaging_Form.xlsx
Organ Tracking and Validating System
53
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
Patient Safety Contact Management Form
151
Patient Safety Contact Management Form
Patient Transfer Form
152
Patient Transfer Form
Pediatric Heart Candidate Listing Registration
81
Pediatric Heart Candidate Listing Registration
Pediatric Heart and HeartLung Status 1A Extension and Appeal Justification Forms
124
Pediatric Heart and HeartLung Status 1A Extension and Appeal Justification Forms
Pediatric Heart and HeartLung Status 1A Initial Justification Form
123
Pediatric Heart and HeartLung Status 1A Initial Justification Form
Pediatric Heart and HeartLung Status 1B Initial Justification Form
125
Pediatric Heart and HeartLung Status 1B Initial Justification Form
Pediatric HeartLung Candidate Listing Registration
83
Pediatric Lung Candidate Listing Registration
Pediatric Intestine Candidate Listing Registration
79
Pediatric Intestine Candidate Listing Registration
Pediatric Kidney Candidate Listing Registration
69
Pediatric Kidney Candidate Listing Registration Form
Pediatric Kidney Pancreas Candidate Listing Registration
71
Pediatric Kidney Pancreas Candidate Listing Registration
Pediatric Liver Candidate Listing Registration
77
Pediatric Liver Candidate Listing Registration
Pediatric Liver Status 1A Initial Justification and Extension Form
106
Pediatric Liver Status 1A Initial Justification and Extension Form
Pediatric Liver Status 1B Initial Justification and Extension Form
107
Pediatric Liver Status 1B Initial Justification and Extension Form
Pediatric Lung Candidate Listing Registration
85
Pediatric Lung Candidate Listing Registration
Pediatric Lung Priority 1 Status Justification Form
144
Pediatric Lung Priority 1 Status Justification Form
Pediatric Pancreas Candidate Listing Registration
73
Pediatric Pancreas Candidate Listing Registration
Pediatric Pancreas Islet Listing Registration
75
Pediatric Pancreas Islet Listing Registration
Potential Disease Transmission Report
60
Potential Disease Transmission Report_Form.xlsx
Potential Transplant Recipient
64
Potential Transplant Recipient
Prior Living Donor Priority
103
Prior Living Donor Priority
Recipient Histocompatibility Form
5
Recipient Histocompatibility
Request to Unlock Form
61
Request to Unlock Form_Form.xlsx
Review Board Voter Form
145
Review Board Voter Form
Safety Situation
59
Safety Situation_Form.xlsx
Transplant Center Contact Management
67
Transplant Center Contact Management
VCA Abdominal Wall Candidate Listing Registration
87
VCA Abdominal Wall Candidate Listing Registration
VCA External Male Genitalia Candidate Listing Registration
88
VCA Head and Neck Candidate Listing Registration
VCA Head and Neck Candidate Listing Registration
89
VCA Head and Neck Candidate Listing Registration
VCA Lower Limb Candidate Listing Registration
90
VCA Lower Limb Candidate Listing Registration
VCA Musculoskeletal Composite Graft Segment Candidate Listing Registration
91
VCA Musculoskeletal Composite Graft Segment Candidate Listing Registration
VCA Other Genitourinary Organ Candidate Listing Registration
92
VCA Other Genitourinary Organ Candidate Listing Registration
VCA Spleen Candidate Listing Registration
93
VCA Spleen Candidate Listing Registration
VCA Transplant Candidate Registration (TCR)
50
VCA Transplant Candidate Registration_Form.xlsx
VCA Transplant Recipient Follow Up (TRF)
51
VCA Transplant Recipient Follow Up_Form_clean.xlsx
VCA Transplant Recipient Registration (TRR)
50
VCA Transplant Recipient Registration_Form_clean.xlsx
VCA Upper Limb Candidate Listing Registration
94
VCA Upper Limb Candidate Listing Registration
VCA Uterus Candidate Listing Registration
95
VCA Uterus Candidate Listing Registration
VCA Vascularized Gland Candidate Listing Registration
96
VCA Vascularized Gland Candidate Listing Registration
ICR Summary of Burden
Total Request
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
3,085,442
3,184,246
0
-98,804
0
0
Annual Time Burden (Hours)
903,603
851,578
0
52,025
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:
Total Burden Hours for the OPTN data collection have been updated to reflect annual data from the prior year.
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:
Catherine Bourassa 301 443-5039 cbourassa@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:
10/14/2026
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