Request to Unlock Form

OMB No. 0915-0157; Expiration Date: XX/XX/202X

Request to Unlock Form

Submission deadlines are clarified and extended for certain data collection instruments used by TIEDI^®. Data values will be “locked” after the established deadlines. Users can “unlock” data after the deadlines to make changes, by describing why the changes are needed and acknowledging leadership awareness of the changes. The OPTN will provide annual reporting to the OPTN Board of Directors detailing the frequency of, and reasons for, the data changes.

Forms Affected -

Locks 60 days after generation:

• Deceased Donor Registration

• Donor Histocompatibility

• Recipient Histocompatibility

Locks 90 days after generation:

• Living Donor Registration

• Transplant Candidate Registration

• Transplant Recipient Registration

• Living Donor Follow-up

• Transplant Recipient Follow-up

In order to continue editing the data, please provide the following information. All fields are required.

Explanation: Enter the explanation for the change (Values: Internal auditing results, External auditing results, New information from an internal source, New information from an external source, Delayed reporting due to staff resource issues, Other explanation).

Approved By First Name: Enter the first name of the organizational leader who approved the changes.

Last Name: Enter the last name of the organization leader who approved the changes.

Other Explanation: Enter additional information, if applicable.

Note: Once the above information is supplied, the page will become editable until it is saved or validated, at which point the page will lock again.

Public Burden Statement: The private, non-profit Organ Procurement and Transplantation Network (OPTN) collects this information in order to perform the following OPTN functions: to assess whether applicants meet OPTN Bylaw requirements for membership in the OPTN; and to monitor compliance of member organizations with OPTN Obligations. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0157 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit per 42 CFR §121.11(b)(2). All data collected will be subject to Privacy Act protection (Privacy Act System of Records #09-15-0055). Data collected by the private non-profit OPTN also are well protected by a number of the Contractor’s security features. The Contractor’s security system meets or exceeds the requirements as prescribed by OMB Circular A-130, Appendix III, Security of Federal Automated Information Systems, and the Departments Automated Information Systems Security Program Handbook. The public reporting burden for this collection of information is estimated to average 0.27 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or paperwork@hrsa.gov.   

OPTN Restricted

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