Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Prepaid Health Plan Cost Report (HCPPS)	Modified	27	720	0	Instruction
					Form	CMS-276	4th Quarter Interim Cost Report
					Form	CMS-276	Budget Forecast
					Form	CMS-276	Semi Annual Cost Report
					Form	CMS-276	Final Cost Report
Prepaid Health Plan Cost Report (HMO)	Modified	30	1080	0	Instruction
					Form	CMS-276	Budget Forecast
					Form	CMS-276	Interim Report
					Form	CMS-276	4th Quarter Interim Report
					Form	CMS-276	Final Cost Report
Total burden requested under this ICR:		57	1800	0
To view an IC, click on IC Title