Information Collection

Organ Procurement/histocompatibility Laboratory Statement Of Reimbursable Cost

IC 112892 under ICR 198503-0938-019 · OMB 0938-0102.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0102 can be found here:

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Information Collection (IC) Details

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IC Title:	ORGAN PROCUREMENT/HISTOCOMPATIBILITY LABORATORY STATEMENT OF REIMBURSABLE COST	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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	HCFA-216				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 74	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	74	17	57
Annual IC Time Burden (Hours)	3,330	765	2,565
Annual IC Cost Burden (Dollars)	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.