OMB control number

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

OMB 0938-0102 · HHS/CMS.

OMB 0938-0102

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.

The latest form for Organ Procurement Organization/Histocompatibility Laboratory Cost Report (CMS-216-94) expires 2027-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 216-94 Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions (CMS-216-94) Form
2024 PRA OPO HCL - Supporting Statement-Form CMS-216-94.docx Supporting Statement A
Organ Procurement Organization/Histcompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions (CMS-216-94) Form

All Historical Document Collections

202409-0938-021	Extension without change of a currently approved collection	2024-10-02
202110-0938-010 Approved without change	Reinstatement without change of a previously approved collection	2021-10-18
201709-0938-010 Approved without change	Extension without change of a currently approved collection	2017-09-29
201407-0938-006 Approved without change	Extension without change of a currently approved collection	2014-07-08
201105-0938-003 Approved without change	Extension without change of a currently approved collection	2011-05-13
200805-0938-007 Approved without change	Extension without change of a currently approved collection	2008-05-19
200607-0938-005 Approved without change	Extension without change of a currently approved collection	2006-07-06
200306-0938-006 Approved without change	Extension without change of a currently approved collection	2003-06-13
200008-0938-010 Approved without change	Extension without change of a currently approved collection	2000-08-29
199708-0938-004 Approved without change	Extension without change of a currently approved collection	1997-08-19
199410-0938-001 Approved without change	Revision of a currently approved collection	1994-10-07
199310-0938-002 Approved without change	Reinstatement with change of a previously approved collection	1993-10-14
198909-0938-002 Approved without change	Revision of a currently approved collection	1989-09-27
198608-0938-008 Approved without change	Revision of a currently approved collection	1986-08-14
198503-0938-019 Approved without change	Reinstatement with change of a previously approved collection	1985-03-26
198211-0938-001 Approved without change	Revision of a currently approved collection	1982-11-10
198112-0938-003 Approved without change	Revision of a currently approved collection	1981-12-01
198109-0938-007 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-09-01
198007-0938-001 Approved without change	New collection (Request for a new OMB Control Number)	1980-07-14