Adult and Pediatric Lung and HeartLung Goal Exception Form

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
146. Adult and Pediatric Lung and HeartLung Goal Exception Form_Instructions.docx Instruction
146 Adult and Pediatric Lung and HeartLung Goal Exception Fo 146. Adult and Pediatric Lung and HeartLung Goal Exception Form_Form.xlsx Form

Information Collection (IC) Details

IC Title:	Adult and Pediatric Lung and HeartLung Goal Exception Form	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
Instruction			146. Adult and Pediatric Lung and HeartLung Goal Exception Form_Instructions.docx		Yes	Yes	Fillable Fileable
Form	146	Adult and Pediatric Lung and HeartLung Goal Exception Form	146. Adult and Pediatric Lung and HeartLung Goal Exception Form_Form.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act System of Records 09-15-0055	FR Citation: 87 FR 46967

Number of Respondents: 149	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
Annual Number of Responses for this IC	554	554
Annual IC Time Burden (Hours)	416	416
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.