OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Prepaid Health Plan Cost Report (CMS-276)

OMB 0938-0165 ยท HHS/CMS.

OMB 0938-0165

These forms are needed to establish the reasonable cost of providing covered services to the enrolled Medicare population of an HMO/CMP/HCPP in accordance with Sections 1876 and 1833 of the Social Security Act.

The latest form for Prepaid Health Plan Cost Report (CMS-276) expires 2028-12-31 and is listed under ICR 202507-0938-025.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-276 Final Cost ReportForm
Form CMS-276 Interim Cost ReportForm
Form CMS-276 Budget ForecastForm
Form CMS-276 4th Quarter Interim Cost ReportForm
Form CMS-276 Final Cost ReportForm
Form CMS-276 4th Quarter Interim ReportForm
Form CMS-276 Interim Cost ReportForm
Form CMS-276 Budget ForecastForm
CMS-276 - Supporting Statement A (2025 version 8).docxSupporting Statement A
Comment - mab-mtzm-jyxs.pdfPublic Comments
Comment - maw-vgv5-lo78.pdf (document unavailable)Public Comments
Health Care Prepayment Plans (HCPPs) under Section 1833 Form
Health Care Prepayment Plans (HCPPs) under Section 1833 Form
Health Care Prepayment Plans (HCPPs) under Section 1833 Form
Health Care Prepayment Plans (HCPPs) under Section 1833 Form
Health Care Prepayment Plans (HCPPs) under Section 1833 Instruction
Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876 Form
Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876 Form
Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876 Form
Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876 Form
Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876 Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202507-0938-025 Revision of a currently approved collection 2025-07-29
202203-0938-008 Revision of a currently approved collection 2022-03-30 Approved without change
201904-0938-011 Revision of a currently approved collection 2019-04-30 Approved with change
201605-0938-015 Revision of a currently approved collection 2016-05-27 Approved with change
201305-0938-010 Reinstatement with change of a previously approved collection 2013-05-20 Approved without change
200908-0938-012 Extension without change of a currently approved collection 2009-08-31 Approved without change
200605-0938-007 Extension without change of a currently approved collection 2006-05-15 Approved without change
200301-0938-004 Revision of a currently approved collection 2003-01-06 Approved without change
199910-0938-004 Revision of a currently approved collection 1999-10-26 Approved without change
199608-0938-007 Revision of a currently approved collection 1996-08-14 Approved without change
199307-0938-007 Reinstatement with change of a previously approved collection 1993-07-07 Approved without change
199211-0938-001 Reinstatement with change of a previously approved collection 1992-11-04 Approved without change
199105-0938-017 No material or nonsubstantive change to a currently approved collection 1991-05-07 Approved with change
199012-0938-012 Reinstatement with change of a previously approved collection 1990-12-18 Approved without change
198109-0938-006 No material or nonsubstantive change to a currently approved collection 1981-09-01 Approved with change
198104-0938-003 New collection (Request for a new OMB Control Number) 1981-04-14 Approved without change

OMB Details

Health Care Prepayment Plans (HCPPs) under Section 1833

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form CMS-276Final Cost ReportFillable FileableForm
Form CMS-276Interim Cost ReportFillable FileableForm
Form CMS-276Budget ForecastFillable FileableForm
Form CMS-2764th Quarter Interim Cost ReportFillable FileableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.