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

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

Documents and Forms

Document Name Document Type
Form 216-94 Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions (CMS-216-94) Form
Organ Procurement OrganizationHistocompatibility Laboratory Cost Report Instruction.docx Instruction
Organ Procurement OrganizationHistocompatibility Laboratory Cost Report Instruction.docx Instruction
216-94 Organ Procurement Organization/Histocompatibility Labora 216-94 Form.xlsx Form
216-94 Organ Procurement Organization/Histocompatibility Labora 216-94 Form.xlsx Form

Information Collection (IC) Details

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:

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

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	95	95
Annual IC Time Burden (Hours)	4,275	4,275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.