Prepaid Health Plan Cost Report (HMO)

Prepaid Health Plan Cost Report

OMB: 0938-0165

IC ID: 190488

Information Collection (IC) Details

View Information Collection (IC)

Prepaid Health Plan Cost Report (HMO)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 417.576 42 CFR 417.572

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction C. Cost Report Instructions-PRA Final Version.doc Yes No Fillable Fileable
Form CMS-276 Interim Report H. Revised Semi-Annual Interim Cost Report vj508.pdf Yes Yes Fillable Fileable
Form CMS-276 4th Quarter Interim Report K. Revised 4th Quarter Interim Cost Report vj508.pdf Yes Yes Fillable Fileable
Form CMS-276 Budget Forecast E Revised Budget Cost Report vvj508.pdf Yes Yes Fillable Fileable
Form CMS-276 Final Cost Report N. Revised Final Cost Report vj508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

16 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 64 0 -12 0 0 76
Annual IC Time Burden (Hours) 3,008 0 -564 0 0 3,572
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy