OPTN Personnel Change Application

Organ Procurement and Transplantation Network

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Document Name Document Type
Form 1 OPTN Personnel Change Application Form and Instruction
1 F_Cover_Instructions_Personnel F_Cover_and_Instructions_Personnel Change Appl_2010_Nov.doc www.optn.org Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Personnel Change Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 121

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	F_Cover_Instructions_Personnel	F_Cover_and_Instructions_Personnel Change Appl_2010_Nov.doc	www.optn.org	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 324	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	324	324
Annual IC Time Burden (Hours)	3,240	3,240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.