Annual Report and Recordkeeping Requirements

Medical Loss Ratio (MLR) Report for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)

OMB: 0938-1232

IC ID: 209359

Information Collection (IC) Details

View Information Collection (IC)

Annual Report and Recordkeeping Requirements
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 508_CMS-10476_Attachment_C_MLR_Report_Instructions.pdf Yes No Printable Only
Form CMS-10476 MLR Report 508_CMS-10476_Attachment_B_MLR_Report.pdf Yes Yes Fillable Printable
Other-Crosswalk 508_CMS-10476_Attachment_D_Crosswalk.pdf No   Printable Only

Health Health Care Services

 

616 25
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 616 0 0 0 0 616
Annual IC Time Burden (Hours) 28,980 0 0 0 0 28,980
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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