Information Collection

Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)

IC 186438 under ICR 201712-0938-001 · OMB 0938-1051.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1051 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CY2018_4_Cost_Plan_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_3_DE_SNP_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_7_HMO_MA_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_1_HMO_MAPD_ISNP_CSNP_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_6_MSA_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_9_PDP_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_5_PFFS_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_8_PPO_MA_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2018_2_PPO_MAPD_ISNP_CSNP_ANOC_EOC_05122017 CLEAN.docx	Instruction
CY2019_1_HMO_MAPD_ISNP_CSNP_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_2_PPO_MAPD_ISNP_CSNP_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_3_DE_SNP_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_4_Cost_Plan_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_5_PFFS_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_6_MSA_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_7_HMO_MA_ANOC_ONLY_CLEAN_12122017.docx	Instruction
CY2019_8_PPO_MA_ANOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_9_PDP_ANOC_ONLY_CLEAN_12122017.docx	Instruction
CY2019_1_HMO_MAPD_ISNP_CSNP_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_2_PPO_MAPD_ISNP_CSNP_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_3_DE_SNP_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_4_Cost_Plan_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_5_PFFS_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_6_MSA_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_7_HMO_MA_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_8_PPO_MA_EOC_ONLY_CLEAN_508_12122017.docx	Instruction
CY2019_9_PDP_EOC_ONLY_CLEAN_508_12122017.docx	Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.111(a)(3) 42 CFR 423.128(a)(3)

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	CY2018_4_Cost_Plan_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_3_DE_SNP_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_7_HMO_MA_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_1_HMO_MAPD_ISNP_CSNP_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_6_MSA_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_9_PDP_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_5_PFFS_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_8_PPO_MA_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2018_2_PPO_MAPD_ISNP_CSNP_ANOC_EOC_05122017 CLEAN.docx	Yes	No	Fillable Printable
Instruction	CY2019_1_HMO_MAPD_ISNP_CSNP_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_2_PPO_MAPD_ISNP_CSNP_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_3_DE_SNP_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_4_Cost_Plan_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_5_PFFS_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_6_MSA_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_7_HMO_MA_ANOC_ONLY_CLEAN_12122017.docx	No		Fillable Fileable
Instruction	CY2019_8_PPO_MA_ANOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_9_PDP_ANOC_ONLY_CLEAN_12122017.docx	No		Fillable Fileable
Instruction	CY2019_1_HMO_MAPD_ISNP_CSNP_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_2_PPO_MAPD_ISNP_CSNP_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_3_DE_SNP_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_4_Cost_Plan_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_5_PFFS_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_6_MSA_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_7_HMO_MA_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_8_PPO_MA_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable
Instruction	CY2019_9_PDP_EOC_ONLY_CLEAN_508_12122017.docx	No		Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 805

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	805	0	805
Annual IC Time Burden (Hours)	9,660	0	9,660
Annual IC Cost Burden (Dollars)	8,068,730,000	8,068,730,000	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.