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

Organ Procurement Organization/Histocompatibility Laboratory Cost Report (CMS-216-94)

OMB: 0938-0102

IC ID: 43650

Information Collection (IC) Details

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Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions (CMS-216-94)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 413.20 42 CFR 413.24

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

Health Health Care Services

 

107 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  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 107 0 0 -8 0 115
Annual IC Time Burden (Hours) 4,815 0 0 -360 0 5,175
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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