Annual MLR Report

Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)

⚠️ Notice: This information collection may be referencing outdated material.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

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	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 %

	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

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.