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

OMB 0938-0512

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.

The latest form for Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348 (CMS-576 and CMS-576A) expires 2023-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-576A Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348 Form and Instruction
CMS-576 and CMS-576A Responses to 60 Day Comments.09.12.23.docx Supplementary Document
CMS-576 and CMS-576A Supporting Statement 09.11.23.docx Supporting Statement A
Organ Procurement Organization's Health Insurance Benefits Agreement and Supporting Regulations 42 CFR 486.301-486.348 Form and Instruction

All Historical Document Collections

202310-0938-001 Approved without change	Reinstatement with change of a previously approved collection	2023-10-18
201910-0938-006 Approved with change	Revision of a currently approved collection	2019-10-29
201605-0938-008 Approved without change	Extension without change of a currently approved collection	2016-05-12
201304-0938-005 Approved without change	Extension without change of a currently approved collection	2013-04-23
201002-0938-007 Approved without change	Extension without change of a currently approved collection	2010-02-24
200612-0938-004 Approved without change	Extension without change of a currently approved collection	2006-12-13
200606-0938-005 Approved without change	Revision of a currently approved collection	2006-06-20
200311-0938-001 Approved without change	Extension without change of a currently approved collection	2003-11-12
200109-0938-003 Approved without change	Extension without change of a currently approved collection	2001-09-25
199807-0938-003 Approved without change	Reinstatement without change of a previously approved collection	1998-07-09
199603-0938-008 Approved without change	Revision of a currently approved collection	1996-03-22
199306-0938-007 Approved without change	Reinstatement with change of a previously approved collection	1993-06-28
198807-0938-004 Approved without change	Revision of a currently approved collection	1988-07-19
198709-0938-001 Approved without change	New collection (Request for a new OMB Control Number)	1987-09-01