Adult Kidney Candidate Listing Registration

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
Form 71 Adult Kidney Candidate Listing Registration Form
71. Adult Kidney Candidate Listing Registration_Documentation.docx Instruction
71 Adult Kidney Candidate Listing Registration 71. Adult Kidney Candidate Listing Registration_Form.xlsx Form

Information Collection (IC) Details

IC Title:	Adult Kidney Candidate Listing Registration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	71	Adult Kidney Candidate Listing Registration	71. Adult Kidney Candidate Listing Registration_Form.xlsx		Yes	Yes	Fillable Fileable
Instruction			71. Adult Kidney Candidate Listing Registration_Documentation.docx		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: 228	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
Annual Number of Responses for this IC	46,724	46,724
Annual IC Time Burden (Hours)	24,296	24,296
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.