Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions and Supporting Regulations Contained in 42 CFR 413.20 and 413.24

ICR 200306-0938-006

OMB: 0938-0102

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0102 200306-0938-006
Historical Active 200008-0938-010
HHS/CMS
Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions and Supporting Regulations Contained in 42 CFR 413.20 and 413.24
Extension without change of a currently approved collection   No
Regular
Approved without change 08/25/2003
Retrieve Notice of Action (NOA) 06/13/2003
  Inventory as of this Action Requested Previously Approved
08/31/2006 08/31/2006 10/31/2003
108 0 108
4,860 0 4,860
0 0 0

This form is required by statute and regulation for participation in the medicare program. The information is used to determine payment for medicare. Organ procurement organizations and histocompatibility laboratories are the users.

None
None


No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 108 108 0 0 0 0
Annual Time Burden (Hours) 4,860 4,860 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/13/2003


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