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⚠️ Notice: This information collection may be referencing outdated material.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
CMS 10418 2012 MLRA Instructions.pdf Instruction
CMS 10418 MLRA Instructions.docx Instruction
CMS-10418 MLR_Annual_Form CMS 10418 MLR PRA Package MLR Form Template.xlsx Form

Information Collection (IC) Details

IC Title:	Annual MLR Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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			CMS 10418 2012 MLRA Instructions.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10418	MLR_Annual_Form	CMS 10418 MLR PRA Package MLR Form Template.xlsx	Yes	Yes	Fillable Fileable
Instruction			CMS 10418 MLRA Instructions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 502	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,087	-2,447	5,534
Annual IC Time Burden (Hours)	196,668	-155,895	352,563
Annual IC Cost Burden (Dollars)	0	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.