View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 417.572 42 CFR 417.576

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

Health Health Care Services

 

6 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 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

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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