Liver Transplant Recipient Follow Up Post 5 Year (TRF)

Data System for Organ Procurement and Transplantation Network

Documents and Forms

Document Name Document Type
Liver Post 5 Year Transplant Recipient Follow_Instructions.docx Instruction
Liver Post 5 Year Transplant Recipient Follow_Instructions.docx Instruction
Liver Transplant Recipient Follow Up Post 5 Year_Form_redline.xlsx Other-Redline
Liver Transplant Recipient Follow Up Post 5 Year_Form_redline.xlsx Other-Redline
27 Liver Transplant Recipient Follow Up Post 5 Year_Form_cl Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx Form
27 Liver Transplant Recipient Follow Up Post 5 Year_Form_cl Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx Form

Information Collection (IC) Details

IC Title:	Liver Transplant Recipient Follow Up Post 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			Liver Post 5 Year Transplant Recipient Follow_Instructions.docx	Yes	Yes	Fillable Fileable
Form	27	Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Liver Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Yes	Yes	Fillable Fileable
Other-Redline			Liver Transplant Recipient Follow Up Post 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: 143	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	54,958	8,733	46,225
Annual IC Time Burden (Hours)	27,479	4,366	23,113
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.