Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Prepaid Health Plan Cost Report (HCPPS)	Modified	30	800	0	Form	276-99	Prepaid Health Plan Cost Report Worksheet
					Form	CMS-276	Final Cost Report
					Form	CMS-276	Budget Forecast
					Instruction
					Form	CMS-276	Inventory-Cost Report
Prepaid Health Plan Cost Report (HMO)	Modified	76	3572	0	Form	CMS-276	4th Quarter Cost Report
					Instruction
					Form	CMS-276	Interim Report
					Form	CMS-276	Final Cost Report
					Form	CMS-276	Budget Forecast
Total burden requested under this ICR:		106	4372	0
To view an IC, click on IC Title