OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876

IC 190488 under ICR 202507-0938-025 · OMB 0938-0165.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-276
Budget Forecast Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876		 Form
Form CMS-276
Interim Cost Report Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876		 Form
Form CMS-276
4th Quarter Interim Report Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876		 Form
Form CMS-276
Final Cost Report Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876		 Form
C. Cost Report Instructions CLEAN 508.pdf Instruction
C. Cost Report Instructions CLEAN 508.pdf Instruction
CMS-276 Budget Forecast
E. Budget Forecast- Revised 508.pdf 		Form
CMS-276 Budget Forecast
E. Budget Forecast- Revised 508.pdf 		Form
CMS-276 Interim Cost Report
H. Interim Cost Report - Revised 508.pdf 		Form
CMS-276 Interim Cost Report
H. Interim Cost Report - Revised 508.pdf 		Form
CMS-276 4th Quarter Interim Report
K. 4th Quarter Interim Cost Report - Revised 508.pdf 		Form
CMS-276 4th Quarter Interim Report
K. 4th Quarter Interim Cost Report - Revised 508.pdf 		Form
CMS-276 Final Cost Report
N. Final Cost Report PDF 508.pdf 		Form
CMS-276 Final Cost Report
N. Final Cost Report PDF 508.pdf 		Form
C. Cost Report Instruction Crosswalk 508.pdf
Crosswalk: Instructions		IC Document
C. Cost Report Instruction Crosswalk 508.pdf
Crosswalk: Instructions		IC Document
F. Budget Forecast Crosswalk 508.pdf
Crosswalk: Budget Forecast		IC Document
F. Budget Forecast Crosswalk 508.pdf
Crosswalk: Budget Forecast		IC Document
I. Interim Cost Report Crosswalk 508.pdf
Crosswalk: Interim Cost Report		IC Document
I. Interim Cost Report Crosswalk 508.pdf
Crosswalk: Interim Cost Report		IC Document
L. 4thQtrInterim Revised Cost Rep Crosswalk 508.pdf
Crosswalk: 4th Quarter Interim Cost Report		IC Document
L. 4thQtrInterim Revised Cost Rep Crosswalk 508.pdf
Crosswalk: 4th Quarter Interim Cost Report		IC Document
O. Final Cost Report Crosswalk 508.pdf
Crosswalk: Final Cost Report		IC Document
O. Final Cost Report Crosswalk 508.pdf
Crosswalk: Final Cost Report		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes No Fillable Fileable
Form CMS-276 Yes Yes Fillable Fileable
Form CMS-276 Yes Yes Fillable Fileable
Form CMS-276 Yes Yes Fillable Fileable
Form CMS-276 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 18 0 -9 0 0 27
Annual IC Time Burden (Hours) 648 0 -324 0 0 972
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Crosswalk: Instructions 07/29/2025
Crosswalk: Budget Forecast 07/29/2025
Crosswalk: Interim Cost Report 07/29/2025
Crosswalk: 4th Quarter Interim Cost Report 07/29/2025
Crosswalk: Final Cost Report 07/29/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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