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Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)
Data System for Organ Procurement and Transplantation Network
OMB: 0915-0157
IC ID: 214127
OMB.report
HHS/HSA
OMB 0915-0157
ICR 202306-0915-003
IC 214127
( )
Documents and Forms
Document Name
Document Type
HeartLung Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx
Instruction
HeartLung Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx
Instruction
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.
HeartLung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
Form
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.
HeartLung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
HeartLung Transplant Recipient Follow Up 1 to 5 Year_Instructions.docx
Yes
Yes
Fillable Fileable
Form
21
Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
HeartLung Transplant Recipient Follow Up 1_5 Year_Form.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Privacy Act System of Records Notice #09-15-0055
FR Citation:
87 FR 46967
Number of Respondents:
70
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
147
0
68
0
0
79
Annual IC Time Burden (Hours)
162
0
75
0
0
87
Annual IC Cost Burden (Dollars)
0
0
0
0
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.