Annual Reporting and Recordkeeping Requirements

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1232 can be found here:

Documents and Forms

Document Name Document Type
Attachment C - CY 2023 MLR Report Filing Instructions.pdf Instruction
Attachment C - CY 2023 MLR Report Filing Instructions.pdf Instruction
CMS-10476 MLR Report Attachment B - CY2023 MLR Report Workbook.pdf Form
CMS-10476 MLR Report Attachment B - CY2023 MLR Report Workbook.pdf Form

Information Collection (IC) Details

IC Title:	Annual Reporting and Recordkeeping Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment C - CY 2023 MLR Report Filing Instructions.pdf		Yes	No	Printable Only
Form	CMS-10476	MLR Report	Attachment B - CY2023 MLR Report Workbook.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 601	Number of Respondents for Small Entity: 25

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	601	14	587
Annual IC Time Burden (Hours)	36,748	15,589	21,159
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.