Information Collection

Annual MLR Report

IC 201981 under ICR 201402-0938-006 · OMB 0938-1164.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10418 Annual MLR Report	Form
2013 MLR Form Instructions - Revised PRA 2014 321 CLEAN.pdf	Instruction
CMS-10418 MLP Annual Report 2013_MLR-A_Template_04.00v2.xlsx	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10418	MLP Annual Report	2013_MLR-A_Template_04.00v2.xlsx		Yes	Yes	Fillable Fileable
Instruction			2013 MLR Form Instructions - Revised PRA 2014 321 CLEAN.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 522

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,394	307	3,087
Annual IC Time Burden (Hours)	216,435	19,767	196,668
Annual IC Cost Burden (Dollars)	0	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.