Annual MLR Report

Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1164 can be found here:

Documents and Forms

Document Name Document Type
508CMS-10418_2012 0404MLRAnnualFormInstructionsFinalwTOC.pdf Instruction
2012 0510 MLR Annual Form Instructions FINAL.docx Instruction
CMS-10418 .MLR_Annual_Form CMS-10418.MLR_Annual_Form.xlsx Form

Information Collection (IC) Details

IC Title:	Annual MLR Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 158

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2012 0510 MLR Annual Form Instructions FINAL.docx	Yes	No	Fillable Fileable
Form	CMS-10418	.MLR_Annual_Form	CMS-10418.MLR_Annual_Form.xlsx	Yes	Yes	Fillable Fileable
Instruction			508CMS-10418_2012 0404MLRAnnualFormInstructionsFinalwTOC.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 527	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	5,534	5,534
Annual IC Time Burden (Hours)	352,563	352,563
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.