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

ICR 202409-0938-021

OMB: 0938-0102

Federal Form Document

ICR Details
0938-0102 202409-0938-021
Received in OIRA 202110-0938-010
HHS/CMS CM-FFS
Organ Procurement Organization/Histocompatibility Laboratory Cost Report (CMS-216-94)
Extension without change of a currently approved collection   No
Regular 10/02/2024
  Requested Previously Approved
36 Months From Approved 11/30/2024
95 95
4,275 4,275
0 0

This form is required by statue and regulation for participation in the Medicare program. The information is used to determine payment for Medicare. Organ Procurement Organizations and Histocompatibility Laboratories are the users.

Statute at Large: 18 Stat. 1861
   Statute at Large: 18 Stat. 1881
   Statute at Large: 18 Stat. 1881
  
None

Not associated with rulemaking

  89 FR 53625 06/27/2024
89 FR 73097 09/09/2024
No

  Total Request 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 95 95 0 0 0 0
Annual Time Burden (Hours) 4,275 4,275 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$314,630
No
    No
    No
No
No
No
No
William Parham 4107864669

  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.
10/02/2024


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