OPTN Membership Application for Transplant Hospitals and Programs

Organ Procurement and Transplantation Network Application Form

Documents and Forms

Document Name Document Type
Form 1 OPTN Membership Application for Transplant Hospitals and Programs Form and Instruction
1 OPTN Membership Application for Transplant Hospitals and OPTN Membership Application for Transplant Hospitals.docx Form and Instruction
1 OPTN Membership Application for Transplant Hospitals and OPTN Membership Application for Transplant Hospitals.docx Form and Instruction
1 01_OPTN Membership Application for Transplant Hospitals 01_OPTN Membership Application for Transplant Hospitals and Programs CLEAN 10072024.docx Form and Instruction
1 01_OPTN Membership Application for Transplant Hospitals 01_OPTN Membership Application for Transplant Hospitals and Programs CLEAN 10072024.docx Form and Instruction
1 01_OPTN Membership Application for Transplant Hospitals 01_OPTN Membership Application for Transplant Hospitals and Programs REDLINE 10072024.docx Form and Instruction
1 01_OPTN Membership Application for Transplant Hospitals 01_OPTN Membership Application for Transplant Hospitals and Programs REDLINE 10072024.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OPTN Membership Application for Transplant Hospitals and Programs	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	OPTN Membership Application for Transplant Hospitals and Programs.docx	OPTN Membership Application for Transplant Hospitals.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	01_OPTN Membership Application for Transplant Hospitals and Programs CLEAN 10072024	01_OPTN Membership Application for Transplant Hospitals and Programs CLEAN 10072024.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	01_OPTN Membership Application for Transplant Hospitals and Programs REDLINE 10072024	01_OPTN Membership Application for Transplant Hospitals and Programs REDLINE 10072024.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 251	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	280	280
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.