PREPAID HEALTH PLAN COST REPORT

ICR 199307-0938-007

OMB: 0938-0165

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
113016 Migrated
ICR Details
0938-0165 199307-0938-007
Historical Active 199211-0938-001
HHS/CMS
PREPAID HEALTH PLAN COST REPORT
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 09/28/1993
Retrieve Notice of Action (NOA) 07/07/1993
  Inventory as of this Action Requested Previously Approved
10/31/1996 10/31/1996
8,329 0 0
10,426 0 0
0 0 0

THESE FORMS ARE NEEDED TO ESTABLISH THE REASONABLE COST OF PROVIDING COVERED SERVICES TO THE ENROLLED MEDICARE POPULATION OF AN HMO IN ACCORDANCE WITH SECTION 1876 OF THE SOCIAL SECURITY ACT.

None
None


No

1
IC Title Form No. Form Name
PREPAID HEALTH PLAN COST REPORT HCFA-276

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 8,329 0 0 8,329 0 0
Annual Time Burden (Hours) 10,426 0 0 10,426 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/07/1993


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