Heart/Lung Transplant Recipient Follow Up 1-5 Year (TRF)

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
21. HeartLung Transplant Recipient Follow Up 1_5 Year_Instructions.docx Instruction
21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_redline.xlsx Other-Redline
21 Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form. 21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx Form

Information Collection (IC) Details

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			21. HeartLung Transplant Recipient Follow Up 1_5 Year_Instructions.docx	Yes	Yes	Fillable Fileable
Form	21	Heart/Lung Transplant Recipient Follow Up 1_5 Year_Form.xlsx	21. HeartLung Transplant Recipient Follow Up 1_5 Year_Form_clean.xlsx	Yes	Yes	Fillable Fileable
Other-Redline			21. HeartLung Transplant Recipient Follow Up 1_5 Year_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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	177	30	147
Annual IC Time Burden (Hours)	195	33	162
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.