OMB control number

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 · HHS/CMS.

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 is listed under ICR 201910-0938-006.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
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All Historical Document Collections

Historical document collections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