Information Collection

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

IC 43650 under ICR 201407-0938-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
pr2_33-508.pdf Instruction
CMS-216-94 Organ Procurement Organization/Histocompatibility Labora CMS-216-94.Instrument.xls Form

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			pr2_33-508.pdf		Yes	No	Printable Only
Form	CMS-216-94	Organ Procurement Organization/Histocompatibility Laboratory Cost Report	CMS-216-94.Instrument.xls		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 107	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: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	107	-8	115
Annual IC Time Burden (Hours)	4,815	-360	5,175
Annual IC Cost Burden (Dollars)	0	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.