Heart/Lung Recipient Registration

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
19. HeartLung Transplant Recipient Registration_Instructions.docx Instruction
19. HeartLung Transplant Recipient Registration_Form_redline.xlsx Other-Redline
19 Heart/Lung Transplant Recipient Registration_Form_clean. 19. HeartLung Transplant Recipient Registration_Form_clean.xlsx Form

Information Collection (IC) Details

IC Title:	Heart/Lung Recipient Registration	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			19. HeartLung Transplant Recipient Registration_Instructions.docx	Yes	Yes	Fillable Fileable
Form	19	Heart/Lung Transplant Recipient Registration_Form_clean.xlsx	19. HeartLung Transplant Recipient Registration_Form_clean.xlsx	Yes	Yes	Fillable Fileable
Other-Redline			19. HeartLung Transplant Recipient Registration_Form_redline.xlsx	Yes	Yes	Fillable Fileable

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: 72	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54	9	45
Annual IC Time Burden (Hours)	113	16	97
Annual IC Cost Burden (Dollars)	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.