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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
pr2_33-508.pdf	Instruction
CMS-216-94 Organ Procurement Organization/Histocompatibility Labora CMS-216-94.Instrument.xls	Form

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:

table that charts list of 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 %

table that charts list of burden
	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

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.