OMB control number

Prepaid Health Plan Cost Report (CMS-276)

OMB 0938-0165 · 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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-276 - Supporting Statement A (2025 version 8).docx Supporting Statement A
Health Care Prepayment Plans (HCPPs) under Section 1833 Instruction
Health Maintenance Organizations (HMOs) and Competitive Medical Plans (CMPs) under Section 1876 Instruction

All Historical Document Collections

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

OMB Details

Health Care Prepayment Plans (HCPPs) under Section 1833

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-276	Final Cost Report	Fillable Fileable	Form
Form CMS-276	Interim Cost Report	Fillable Fileable	Form
Form CMS-276	Budget Forecast	Fillable Fileable	Form
Form CMS-276	4th Quarter Interim Cost Report	Fillable Fileable	Form

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