Potential Disease Transmission Report

Data System for Organ Procurement and Transplantation Network

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Document Name Document Type
Potential Disease Transmission Report_Instructions.docx Instruction
Potential Disease Transmission Report_Instructions.docx Instruction
61 Potential Disease Transmission Report_Form.xlsx Potential Disease Transmission Report_Form.xlsx Form
61 Potential Disease Transmission Report_Form.xlsx Potential Disease Transmission Report_Form.xlsx Form

Information Collection (IC) Details

IC Title:	Potential Disease Transmission Report	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			Potential Disease Transmission Report_Instructions.docx		Yes	Yes	Fillable Fileable
Form	61	Potential Disease Transmission Report_Form.xlsx	Potential Disease Transmission Report_Form.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	392	392
Annual IC Time Burden (Hours)	498	498
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.