Information Collection

Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions (CMS-216-94)

IC 43650 under ICR 200805-0938-007 · OMB 0938-0102.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.20 42 CFR 413.24

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cost Report	CMS-216.pr2_33_toc.doc	Yes	Yes	Paper Only
Other-Cost Report	CMS-216.pr2_3300_to_3390.doc	Yes	Yes	Paper Only
Other-Cost Report	CMS-216.pr2_3395_to_3395.doc	Yes	Yes	Paper Only
Other-Cost Report	CMS-216.R4P233f.xls	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 108

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	4,860	4,860
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.