OPTN Public Organization Membership Application

Organ Procurement and Transplantation Network Application Form

Documents and Forms

Document Name Document Type
Form 15 OPTN Public Organization Membership Application Form and Instruction
15 Membership_PublicOrg Form.docx OPTN Public Organization Membership Application.docx Form and Instruction
15 Membership_PublicOrg Form.docx OPTN Public Organization Membership Application.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Public Organization Membership Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	15	Membership_PublicOrg Form.docx	OPTN Public Organization Membership Application.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	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	Previously Approved
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	2	2
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.