Intestine Transplant Recipient Follow Up 6 Month -5 Year (TRF)

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
Intestine Transplant Recipient Follow Up 6 Month to 5 Year_Instructions.docx Instruction
Intestine Transplant Recipient Follow Up 6 Month to 5 Year_Instructions.docx Instruction
Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_redline.xlsx Other-Redline
Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_redline.xlsx Other-Redline
32 Intestine Transplant Recipient Follow Up 6 Month_5 Year_ Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx Form
32 Intestine Transplant Recipient Follow Up 6 Month_5 Year_ Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx Form

Information Collection (IC) Details

IC Title:	Intestine Transplant Recipient Follow Up 6 Month -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			Intestine Transplant Recipient Follow Up 6 Month to 5 Year_Instructions.docx	Yes	Yes	Fillable Fileable
Form	32	Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Intestine Transplant Recipient Follow Up 6 Month_5 Year_Form_clean.xlsx	Yes	Yes	Fillable Fileable
Other-Redline			Intestine Transplant Recipient Follow Up 6 Month_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: 21	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	Previously Approved
Annual Number of Responses for this IC	421	-103	524
Annual IC Time Burden (Hours)	632	-154	786
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.