(CMS-576A) Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348

ICR 201605-0938-008

OMB: 0938-0512

Federal Form Document

ICR Details
0938-0512 201605-0938-008
Historical Active 201304-0938-005
HHS/CMS 19295
(CMS-576A) Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348
Extension without change of a currently approved collection   No
Regular
Approved without change 10/11/2016
Retrieve Notice of Action (NOA) 05/12/2016
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved 10/31/2016
58 0 58
116 0 116
0 0 0

The information provided on this form serves as a basis for continuing the agreements with CMS and the 58 OPOs for participation in the Medicare and Medicaid programs and for reimbursement of service.

Statute at Large: 19 Stat. 372 Name of Statute: null
   Statute at Large: 18 Stat. 1138 Name of Statute: null
  
None

Not associated with rulemaking

  81 FR 10625 03/01/2016
81 FR 27447 05/06/2016
Yes

  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 58 58 0 0 0 0
Annual Time Burden (Hours) 116 116 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Denise King 410 786-1013 [email protected]

  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.
05/12/2016


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