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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
2009combinedANOC_EOC_031708FINAL.doc	Instruction

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.