Annual MLR Report

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

OMB: 0938-1164

IC ID: 201981

Information Collection (IC) Details

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Annual MLR Report
 
No Unchanged
 
Mandatory
 
45 CFR 158

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10418 MLR Reporting Form CMS-10418 - 2016-MLR-Reporting-Form-2017-07.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10418 MLR Form Instructions CMS-10418 - 2016 MLR Form Instructions 2017-07.pdf Yes Yes Fillable Fileable
Instruction CMS-10418 - 2016-Risk-Corridor-Plan-Level-Instructions-x.pdf Yes Yes Paper Only
Form CMS-10418 Risk Corridors Plan Level Form CMS-10418 - 2016-Risk-Corridors-Plan-Level-Form-x.xlsx Yes Yes Fillable Fileable

Health Health Care Services

 

545 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 2,442 0 0 0 0 2,442
Annual IC Time Burden (Hours) 151,037 0 0 0 0 151,037
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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