Information Collection

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

IC 43650 under ICR 202110-0938-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-216-94 Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions (CMS-216-94)	Form
CMS-216-94_Chapter_33.pdf	Instruction
CMS-216-94_Chapter_33.pdf	Instruction
CMS-216-94 Organ Procurement Organization and Histocompatibility La CMS-216-94_Cost_Report.xlsx	Form
CMS-216-94 Organ Procurement Organization and Histocompatibility La CMS-216-94_Cost_Report.xlsx	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
Form	CMS-216-94	Organ Procurement Organization and Histocompatibility Laboratory Cost Report	CMS-216-94_Cost_Report.xlsx		Yes	Yes	Fillable Fileable
Instruction			CMS-216-94_Chapter_33.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 95

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	95	-7	102
Annual IC Time Burden (Hours)	4,275	-315	4,590
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.