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

IC 43650 under ICR 202409-0938-021 · OMB 0938-0102.

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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
Form 216-94 Organ Procurement Organization/Histocompatibility Laboratory Cost Report 216-94 Form.xlsx Yes Yes Fillable Fileable
Instruction Organ Procurement OrganizationHistocompatibility Laboratory Cost Report Instruction.docx Yes Yes Fillable Fileable

Health Health Care Services

 

95 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 95 0 0 0 0 95
Annual IC Time Burden (Hours) 4,275 0 0 0 0 4,275
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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