Pediatric Kidney Candidate Listing Registration

OMB No. 0915-0157; Expiration Date: XX/XX/20XX

Pediatric Kidney Candidate Registration

The fields on the Kidney Candidate Registration form contain demographic and basic clinical information about candidates on the national waiting list.

Provider

Transplant Hospital: Verify the transplant hospital name, and that the provider number is the 6-character Medicare identification number of the hospital where the transplant candidate is listed.

24 Hour Contact Phone Number: Verify the transplant center phone number. This is a required field.

Organ Registration

Organ Registration: Verify organ type.

Candidate Identification

SSN: Enter the candidate’s social security number.

Note: SSN cannot:

Contain 00 in the 4th and 5th place (e.g., XXX-00-XXXX is invalid)

Contain 0000 in the last 4 places (e.g., XXX-XX-0000 is invalid)

Begin with 666

Confirm SSN: Re-enter candidate SSN. A green check mark indicates that the data matches.

Date of birth: Enter the candidate's date of birth. This is a required field.

Confirm date of birth: Re-enter candidate date of birth. A green check mark indicates that the data matches.

Center patient ID: Enter the candidate's patient identification number that is assigned by your center, if applicable.

Demographic Information

Last Name: Enter the last name of the candidate. This is a required field.

First Name: Enter the first name of the candidate. This is a required field.

MI: Enter the candidate's middle initial.

Birth sex: Indicate if the patient is Male or Female. Report patient sex (male or female), based on biologic and physiologic traits at birth. This is a required field.

State of Permanent Residence: Select the full name of the state where the candidate's home is located.

Permanent Zip Code: Enter the 5-digit or 9-digit U.S. postal zip code for the address where the candidate's home is located. Note: Make corrections to an incorrect permanent zip code on the Transplant Candidate Registration (TCR) form in TIEDI®. This field cannot be updated from the active list.

Ethnicity: The Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (Office of Management and Budget (OMB) Statistical Policy Directive No. 15) define the minimum standards for collecting and presenting data on race and ethnicity for all Federal reporting. The OPTN collection of ethnicity is aligned to this standard.

OMB defines ethnicity to be whether a person self-identifies as Hispanic origin or not. For this reason, ethnicity is broken out in two categories, (1) Hispanic or Latino or (2) Not Hispanic or Latino. Select one ethnicity category or select ‘Ethnicity Not Reported’ if the candidate did not self-identify. This field is required.

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino

Ethnicity Not Reported

Race: The Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (Office of Management and Budget (OMB) Statistical Policy Directive No. 15) define the minimum standards for collecting and presenting data on race and ethnicity for all Federal reporting. The OPTN collection of race is aligned to this standard. OMB defines race as a person’s self-identification with one or more social groups. ​

An individual can select one or more race categories (1) White, (2) Black or African American, (3) Asian, (4) American Indian or Alaska Native, (5) Native Hawaiian or Other Pacific Islander. Select 'Race Not Reported' if the candidate’s race is not reported.​ This field is required.​

Note: A person may report multiple races. Persons reporting Hispanic or Latino ethnicity may report themselves as any race category or report no race at all.

Select one or more race sub-categories or origins. Select 'Other Origin' if origin is not listed. Select 'Origin Not Reported' if the origin was not self-identified by the person.​​

White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.​

European Descent​

Arab or Middle Eastern​

North African (non-Black)​

Other Origin​

Origin Not Reported​​

Black or African American – A person having origins in any of the Black racial groups of Africa. ​

African American ​

African (Continental)​

West Indian​

Haitian​

Other Origin​

Origin Not Reported ​​

American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.​

American Indian​

Eskimo​

Aleutian​

Alaska Indian ​

Other Origin​

Origin Not Reported​

Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.​

Asian Indian/Indian Sub-Continent ​

Chinese​

Filipino​

Japanese​

Korean​

Vietnamese​

Other Origin​

Origin Not Reported ​

​Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.​

Native Hawaiian​

Guamanian or Chamorro​

Samoan​

Other Origin​

Origin Not Reported​

Race Not Reported – Select if person did not self-identify a race category or origin.​

Kidney Organ Information

Candidate Medical Urgency Status: Indicate the candidate's medical urgency status. If one of the active statuses is selected, the candidate is eligible to appear on a UNet^SM match run. If temporarily inactive is selected, the candidate is non-eligible to appear on the UNet match run. This is a required field.

Active (1)

Active - Medically urgent (2)

Temporarily Inactive (7)

Inactive reason: Select the reason the candidate is inactive.

 

Inactive Reason Code	Description
1	Candidate cannot be contacted
2	Candidate choice
3	Candidate work-up incomplete
4	Insurance issues
5	Medical non-compliance
6	Inappropriate substance use
7	Temporarily too sick
8	Temporarily too well
9	Weight currently inappropriate for transplant
10	Transplanted - removal pending UNET data correction
11	Inactivation due to VAD implantation and/or VAD complication
12	TX Pending
13	Physician/Surgeon unavailable
14	Candidate for living donor transplant only
16	COVID-19 Precaution

 

Note: The inactive reason TX'ed - removal pending UNet data correction is only to be used when a transplant center removed the incorrect candidate from Waitlist due to transplant and is waiting for UNOS to correct the data so that the correct candidate can be removed with the right donor ID. Candidates should not be set to inactive for this reason for more than 5 days.

Number of previous kidney transplants: Indicate the candidate's number of previous kidney transplants. Options 0-9 display in drop-down list. This is a required field.

Number of previous solid organ transplants from OPTN database: Displays the number of previous solid organ transplants on record in the OPTN database for the candidate's SSN. This information is displayed as a reference to help transplant centers provide the correct number of transplants for each candidate. It is possible that the numbers of previous solid organ transplants displayed based on the OPTN database differs from the actual number of transplants for a patient, due to one or more of the following reasons:

• Incorrect SSN

• Previous transplant outside of the U.S.

• Transplant prior to 1987 and not in OPTN database

Number of previous solid organ transplants: Must be provided for calculating an EPTS score. All prior transplants involving any combination of kidney, liver, pancreas, heart, lung, intestine, or VCA organs, including transplants performed outside the U.S., should be provided. All multi-organ transplants in which the organs came from the same donor (including but not limited to liver-kidney, kidney-pancreas, heart-lung, or kidney-pancreas-intestine transplants) should be counted as ONE prior transplant. This is a required field.

Medical Urgency Status Policy

Medical Urgency Status Policy outlines medical urgency classifications in kidney allocation. Increased priority is granted to candidates meeting policy defined criteria and within a 250 nautical mile distribution circle only.

Indicate if the candidate has exhausted or has a contraindication to all dialysis access via each of the following methods:

Vascular access in the upper left extremity

Vascular access in the upper right extremity

Vascular access in the lower left extremity

Vascular access in the lower right extremity

Peritoneal access in the abdomen

Indicate if the candidate has exhausted dialysis access, is currently being dialyzed, or has a contraindication to dialysis via one of the following methods (must select at least one):

Transhepatic IVC Catheter

Translumbar IVC Catheter

Other (must specify)

Nephrologist full name: Enter the candidate's nephrologist attesting to the medical urgency information. This field is required.

Nephrologist NPI: Enter the NPI of the candidate’s nephrologist. This field is required.

Surgeon full name: Enter the candidate's transplant surgeon attesting to the medical urgency information. This field is required.

Surgeon NPI: Enter the NPI of the candidate’s surgeon. This field is required.

Clinical Information

Blood type: Select the candidate's blood type. This is a required field.

Note: A2 is used as shorthand for any blood type A subtype other than A1 (i.e., non-A1, negative for A1). A2B is used as shorthand for any blood type AB subtype other than A1B (i.e., non-A1B, negative for A1B). Policy requires at least two (2) separate blood typings prior to listing. Policy also requires you to review all known available blood type source documents to verify the candidate's blood type.

O

A

B

AB

Z (in Utero Only)

Height: Enter the height of the candidate at the time of listing in the appropriate space, in feet and inches or centimeters. The height must fall between 0 and 7 feet or 1 and 241 centimeters.

Weight: Enter the weight of the candidate at the time of listing in the appropriate space, in pounds or kilograms. The weight must fall between 0 and 650 pounds or 0 and 295 kilograms.

Creatinine clearance level (measured or estimated) less than or equal to 20 mL/min.?: Indicate whether the level is less than or equal to 20 mL/min. This is a required field. If Yes is selected, enter the Creatinine clearance (measured or estimated) level for waiting time qualification and the Date of qualifying test.

GFR (measured or estimated) less than or equal to 20 mL/min.?: Indicate whether the level is less than or equal to 20 mL/min. This is a required field. If Yes is selected, enter the GFR (measured or estimated) for waiting time qualification and the Date of qualifying test.

Note: Estimated GFR must not include a race-based variable.

Has the candidate had regularly administered dialysis for ESRD?: Indicate if the candidate has had regularly administered dialysis for End-Stage Renal Disease (ESRD). For example, if a candidate has only had dialysis treatment for managing an acute kidney injury, select No. However, if a candidate has been treated with dialysis for ESRD, select Yes, even if the candidate is no longer receiving dialysis treatment at present or only received dialysis for a period of time. If the candidate received hemodialysis, peritoneal dialysis, or any other form of renal replacement therapy for ESRD, select Yes. This is a required field.

If the candidate had a prior kidney transplant, only answer Yes if regularly administered dialysis for ESRD occurred after the transplant (Exception: if the previously transplant graft failed immediately and permanently (within 90 days, as defined in OPTN policy), answer Yes if the candidate had dialysis for ESRD prior to the transplant). This is a required field.

If the answer to the question, Has the candidate had regularly administered dialysis for ESRD? is Yes, then the Date of initiation of regularly administered dialysis for ESRD is a required field. The date entered should be the first documented date that the candidate received dialysis treatment for ESRD. Except for candidates being re-listed after immediate and permanent graft failure (within 90 days, as defined in OPTN policy), the date entered cannot be before the date of a previous kidney transplant.

Physician name: Enter the name of the candidate's surgeon/physician. This is a required field if any of the three questions above are answered Yes. 

Physician NPI: Enter the NPI of the candidate’s surgeon/physician. This is a required field if any of the three questions above are answered Yes. 

Current diabetes status: If the candidate never had a diagnosis of diabetes, select Does not Have Diabetes. If the candidate has diabetes, select Type I or Type II. If the candidate has any type of drug-induced diabetes, or both Type I and Type II diabetes, select Other Type of Diabetes. If the candidate was previously diagnosed with diabetes but the diabetic condition has been reversed by significant weight loss, gastric bypass surgery, or successful pancreas (or islet cell) transplantation, such that the patient no longer needs insulin or other diabetes medications, select Does not Have Diabetes. However, if the candidate was previously diagnosed with diabetes and the underlying condition has not been reversed, the candidate should still be indicated as diabetic, even if insulin or other diabetic medications are no longer required (due to, for example, starting dialysis). A patient should not be considered as having diabetes based on a diagnosis of gestational diabetes only. This is a required field.

Does not Have Diabetes should be selected for a non-diabetic candidate.
Type I Diabetes is defined as a disease in which the body does not produce any insulin, most often occurring in children and young adults. People with Type 1 diabetes must take daily insulin injections to stay alive. Type 1 diabetes accounts for 5 to 10 percent of diabetes.
Type II Diabetes is defined as a metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It is the most common form of the disease. Type 2 Diabetes accounts for 90 to 95 percent of diabetes.
Other Type of Diabetes is for any other type of diabetes, such as a candidate with both Type I and Type II, or a drug-induced form of diabetes.

A2/A2B Eligibility

The transplant program must establish and adhere to written policy regarding its program's titer threshold for transplanting A2 and A2B kidneys with blood type B.

Transplant program must confirm candidate's eligibility every 90 days (± 20 days).

Does candidate meet criteria for A2 and A2B (including patient consent)?: Select Yes if the candidate meets criteria for A2 and A2B. By selecting Yes to this field, an eligible candidate will appear on A2 and A2B Deceased Donor matches. Select No if the candidate is permanently ineligible.

Priority for Liver Transplants Recipient on Kidney Match

This section displays for a kidney candidate when the system detects a prior liver transplant within 365 days of the kidney registration. These changes also apply to the kidney-pancreas candidate page IF isolated kidney is checked in the Match List section of the Kidney Pancreas candidate record.

Status of candidate's priority on kidney match as liver recipient: The candidate’s status for prioritization on the kidney match as a liver recipient will display on the kidney candidate view, edit, and edit criteria pages. If ineligible, the system displays a brief description explaining why.

Note: If the candidate has met the consecutive 90 day requirement, the status will display as “Eligible until removed.” If applicable, no additional data needs to be entered and the candidate will remain qualified for prioritization until they are removed from the kidney waiting list.

Most recent liver transplant date: The date of most recent liver transplant displays. This is a read-only field.

Eligibility will expire if qualifying data is not entered by: If the candidate is eligible within the consecutive 90 day window, the system displays the number of days the candidate will remain eligible and the date the eligibility will expire if qualifying data are not entered. The system will evaluate and set candidate’s status for priority on kidney match as liver recipient upon updating the candidate's record. In order for the candidate to qualify for priority for liver transplant on kidney match, the candidate must have at least one of the following:  

• on dialysis

• CrCL (measured or estimated) less than or equal to 20.0 mL/min

• GFR (measured or estimated) less than or equal to 20.0 mL/min

Note: Estimated GFR must not include a race-based variable.

Number of consecutive days candidate has been eligible for priority: If the candidate is eligible within the consecutive 90 day window, the system displays the number of consecutive days they have been eligible.

Date of test or treatment: Enter the date of test or treatment and to confirm dialysis and/or CrCl (measured or estimated) (mL/min) or GFR (measured or estimated) (mL/min) results. If the current date is less than 60 days from the most recent liver transplant date, the data fields will be grayed out.

Note: Estimated GFR must not include a race-based variable.

Medical criteria (five most recent tests or treatments displayed below): The kidney candidate edit page displays up to 5 rows of the most recent data that has been entered for safety net eligibility. To view or enter additional data or update existing data for this section, select the Edit Criteria button.

Additional Organs

Check any additional organs that the candidate may need. Checking organ(s) within this section will not register the candidate on the checked organ waiting list. You will need to complete a registration and verify the accuracy of donor acceptance criteria for each additional organ checked.

Pancreas Islet

Liver

Intestine

Heart

Heart/Lung

Lung

HLA

Indicate the candidate's histocompatibility antigens. At least one value is required for each antigen (A, B, Bw4, Bw6, and DR). The order in which the antigens are entered does not affect the matching and screening process.

Note: If an Additional Organ is selected, then the HLA fields are not required to add the candidate to Waitlist.

Click Confirm HLA and re-enter HLA information in Confirm HLA section. A green check mark indicates that the information matches.

Tested for anti HLA-antibodies: This is a required field.

Yes, antibodies detected

Yes, no antibodies detected

No, not tested

Note: If a candidate was tested and any HLA antibodies were detected, "Yes, antibodies detected" should be reported even if the level of antibodies is below your center’s MFI cutoff level for listing unacceptable antigens.

Unacceptable Antigens

The unacceptable antigens entered are used to determine the Calculated PRA (CPRA) and to screen candidates from matches for donors with antigens listed as unacceptable. 
Select all of the unacceptable antigens and then click the "Calculate" button for the CPRA score.

Select all A unacceptable antigens: Select the candidate's A unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all B unacceptable antigens: Select the candidate's B unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select BW unacceptable antigen: Select the candidate's BW unacceptable antigen, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all C unacceptable antigens: Select the candidate's C unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DR unacceptable antigens: Select the candidate's DR unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DR 51/52/53 unacceptable antigens: Select the candidate's DR 51, 52 and 53 unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DQB1 unacceptable antigens: Select the candidate's DQB1 unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DQA1 unacceptable antigens: Select the candidate's DQA1 unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DPB1 unacceptable antigens: Select the candidate's DPB1 unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DPB1 unacceptable epitopes: Select the candidate's DPB1 unacceptable epitopes, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Select all DPA1 unacceptable antigens: Select the candidate's DPA1 unacceptable antigens, if applicable. Make your selections from the left-hand column and click the arrow to add or remove them to the right-hand column.

Offer Filters

Apply/Do not apply kidney offers for this patient: This field determines whether a candidate is manually excluded from having offer filters applied for them. Select Apply kidney offer filters to have the patient only receive offers defined by your program’s offer filters settings. Select Do not apply kidney offer filters to have the patient receive all offers, regardless of the program’s offer filters settings. By default, the field is set to Apply kidney offer filters.

Candidate and Donor Characteristics

Enter the maximum number of HLA mismatches that the candidate is able to accept. This is a required field.

If the ABDR field is completed, the fields in the second section (AB, ADR, and BDR) and third section (A, B and DR) cannot be entered.

If a field in the second section (AB, ADR and BDR) is chosen, select the maximum number of HLA mismatches the candidate can accept in the appropriate field. Upon entering the maximum number of acceptable mismatches, you must complete the corresponding field in the third section. For the AB field selection, enter a value in the DR field below. For the ADR field selection, enter a value in the B field below. For the BDR field selection, enter a value in the A field below.

The third section (A, B and DR) can be completed without selecting values in the previous sections. Select the maximum acceptable number of HLA mismatches for each locus.

Dual Kidney and En Bloc Opt In

Accept dual kidney?: Select Yes if the candidate will accept a dual kidney for local and import offers. If not, select No. Field displays blank and does not default to yes or no. This is a required field.

Accept en bloc kidney?: Select Yes if the candidate will accept an en bloc kidney for local and import offers. If not, select No. Field displays blank and does not default to yes or no. This is a required field.

Note: If no action is taken by transplant program, these offers will not be received.

Donor Characteristics

Maximum acceptable Kidney Donor Profile Index (KDPI) for 0 ABDR Mismatch – single kidney: Enter the maximum acceptable KDPI for 0 ABDR mismatch that the candidate can accept for local and/or import donors.

Maximum acceptable Kidney Donor Profile Index (KDPI) for non-0 ABDR Mismatch – single kidney: Enter the maximum acceptable KDPI for non-0 ABDR mismatch that the candidate can accept for local and/or import donors.

Maximum acceptable Kidney Donor Profile Index (KDPI) for 0 ABDR Mismatch – dual kidney: Enter the maximum acceptable KDPI for 0 ABDR mismatch that the candidate can accept for local and/or import donors.

Maximum acceptable Kidney Donor Profile Index (KDPI) for non-0 ABDR Mismatch – dual kidney: Enter the maximum acceptable KDPI for non-0 ABDR mismatch that the candidate can accept for local and/or import donors.

Note: You may set four different maximum KDPI values for each candidate: one for local zero-ABDR mismatch offers, another for non-local zero-ABDR mismatch offers, as well as for non zero-mismatches, local versus import. By default, candidates already on the list and willing to accept an ECD will have maximum KDPI values set to 100%, while those not on the ECD list will have maximums of 85%. However, you may edit these maximum acceptable KDPI’s for each candidate on the candidate record, as appropriate. Finally, for your convenience, maximum KDPI values can be set in the Listing defaults so that all newly added candidates will have these maximum values automatically entered in the candidate record at time of listing.

Minimum acceptable donor age: Enter the minimum donor age that the candidate can accept for local and import offers. The age must fall between 0 and 99 years. This field is required.

Maximum acceptable donor age: Enter the maximum donor age that the candidate can accept for local and import offers. The age must fall between 0 and 99 years. The maximum value must only be entered in months if the minimum value is also entered in months (e.g., you are able enter that you will accept donors from 3 months to 3 years in age, but you may NOT enter that you would accept a donor from 1 year to 36 months in age). This field is required.

Maximum acceptable donor BMI: Enter maximum donor body mass index (BMI) in kilogram-meter squared (kg/m²) that the candidate can accept. The BMI must fall between 5.0 and 100.0 kg/m².

Accept DCD donor?: Select Yes if the candidate will accept a DCD (Donation after Circulatory Death) donor for local and import offers. If not, select No. Donation after Circulatory Death (DCD) describes the organ recovery process that may occur following death by irreversible cessation of circulatory and respiratory functions. A DCD donor may also be called a non-heartbeating, asystolic, or donation after cardiac death donor. This field is required.

Medical and Social History

Accept a donor with a history of diabetes?: Select Yes if the candidate will accept a donor with a history of diabetes. If not, select No. A donor should not be considered as having a history of diabetes based on gestational diabetes only.

Accept a donor with a history of hypertension?: Select Yes if the candidate will accept a donor with a history of coronary artery disease. If not, select No.

Infectious Diseases

Accept a Hepatitis B Core antibody positive donor?: Select Yes if the candidate will accept a Hepatitis B core antibody positive donor. If not, select No. This field is required.

Accept an HBV NAT positive donor?: Select Yes if the candidate will accept an HBV NAT positive donor. If not, select No This field is required.

Accept an HCV antibody positive donor?: Select Yes if the candidate will accept an HCV antibody positive donor. If not, select No. This field is required.

Accept an HCV NAT positive donor?: Select Yes if the candidate will accept an HCV NAT positive donor. If not, select No. This field is required.

Hope Act IRB Research

Is the candidate HIV positive and willing to accept an HIV positive Kidney?: Select Yes if the candidate is HIV positive and willing to accept an HIV positive kidney. If not, select No. This field is required.

Recovery

Maximum acceptable warm ischemic time: Enter the donor maximum warm ischemic time in minutes that the candidate can accept. The warm ischemic time must fall between 0 and 180 minutes. This field is required.

Maximum acceptable cold ischemic time: Enter the donor maximum cold ischemic time upon arrival in hours the candidate can accept. The cold ischemic time must fall between 0 and 100 hours. This field is required.

Maximum acceptable percent globally sclerotic glomeruli - Less than 10 glomeruli observed: Enter the donor's maximum percent (%) globally sclerotic glomeruli that the candidate can accept with less than 10 glomeruli observed for local and import offers. The percentage must fall between 0 and 100%. This field is required.

Maximum acceptable percent globally sclerotic glomeruli - 10 or more glomeruli observed: Enter the donor's maximum percent (%) globally sclerotic glomeruli that the candidate can accept with 10 or more glomeruli observed for local and import offers. The percentage must fall between 0 and 100%. This field is required.

Lab Values

Maximum acceptable donor Serum Creatinine - peak: Enter the donor maximum acceptable peak serum creatinine that the candidate can accept for local and import offers in milligrams per deciliter (mg/dL). The number must fall between 0.0 and 10.0 mg/dL. This field is required.

Maximum acceptable donor Serum Creatinine - final: Enter the donor maximum acceptable serum creatinine that the candidate can accept for local and import offers in milligrams per deciliter (mg/dL). The number must fall between 0.0 and 10.0 mg/dL. This field is required.

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.   

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