OPTN Membership Application for Histocompatibility Labs

Organ Procurement and Transplantation Network Application Form

Documents and Forms

Document Name Document Type
Form 10 OPTN Membership Application for Histocompatibility Labs Form and Instruction
10 OPTN Membership Application for Histocompatibility Labor 10_OPTN Membership Histocompatibility Laboratory Application_CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Membership Application for Histocompatibility Labs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10	OPTN Membership Application for Histocompatibility Laboratories	10_OPTN Membership Histocompatibility Laboratory Application_CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Organ Procurement and Transplantation Network (OPTN)/ Scientific Registry of Transplant Recipients (SRTR) Data System, HHS/ HRSA/HSB/DoT, 09-15-0055	FR Citation: 87 FR 46967

Number of Respondents: 138	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	31	1	30
Annual IC Time Burden (Hours)	115	40	75
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.