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Organ Procurement Organization's Request for Designation
Organ Procurement Organization's Request for Designation
OMB: 0938-0512
IC ID: 8129
OMB.report
HHS/CMS
OMB 0938-0512
ICR 199603-0938-008
IC 8129
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0512 can be found here:
2023-10-18 - Reinstatement with change of a previously approved collection
2019-10-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Organ Procurement Organization's Request for Designation
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
Form
HCFA-576
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
80
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
80
0
0
0
0
80
Annual IC Time Burden (Hours)
160
0
0
0
0
160
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.