Information Collection

Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2): CMS-10260

IC 186438 under ICR 200809-0938-004 · OMB 0938-1051.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1051 can be found here:

Documents and Forms

Document Name Document Type
2009combinedANOC_EOC_031708FINAL.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2): CMS-10260	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.111(d)(20 42 CFR 422.80(a)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2009combinedANOC_EOC_031708FINAL.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 670	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	670	670
Annual IC Time Burden (Hours)	8,040	8,040
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.