Information Collection

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

IC 258292 under ICR 202302-0938-006 · OMB 0938-1444.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1444 can be found here:

2025-12-16 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NTDSNPANOCCY202412282022_CS508Cleared.pdf	Instruction
NTDSNPANOCCY20244122023_CS508Cleared.docx	Instruction
NTDSNPCH1CY202412282022_CS508Cleared.pdf	Instruction
NTDSNPCH1CY20244122023_CS508Cleared.DOCX	Instruction
NTDNSPCH2CY202401102023_CS508Cleared.pdf	Instruction
NTSPANDNSPCH2CY202402272023.DOCX	Instruction
NTDNSPCH3CY202412282022_CS508Cleared.pdf	Instruction
NTDNSPCH3CY20244122023_CS508Cleared.docx	Instruction
NTDNSPCH4CY202401102023_CS508Cleared.pdf	Instruction
NTDNSPCH4CY20244122023_CS508Cleared.DOCX	Instruction
NTDSNPCH5CY202412282022_CS508Cleared.pdf	Instruction
NTDSNPCH5CY20244122023_CS508Cleared.DOCX	Instruction
NTDSNPCH6CY202412302022_CS508Cleared.pdf	Instruction
NTSPANDSNPCH6CY202402272023.DOCX	Instruction
NTDSNPCH7CY202412282022_CS508Cleared.pdf	Instruction
NTSPANDSNPCH7CY202402272023.DOCX	Instruction
NTDSNPCH8CY202412282022_CS508Cleared.pdf	Instruction
NTSPANDSNPCH8CY202402272023.DOCX	Instruction
NTDSNPCH9CY202401102023_CS508Cleared.pdf	Instruction
NTSPANDSNPCH9CY202402272023.DOCX	Instruction
NTDSNPCH10CY202412282022_CS508Cleared.pdf	Instruction
NTDSNPCH10CY20244122023_CS508Cleared.DOCX	Instruction
NTDSNPCH11CY202412282022_CS508Cleared.pdf	Instruction
NTSPANDSNPCH11CY202402272023.DOCX	Instruction
NTDSNPCH12CY202412282022_CS508Cleared.pdf	Instruction
NTSPANDSNPCH12CY202402272023.DOCX	Instruction
NTTCHIDSNPANOCCY202402272023.DOCX	Instruction
NTTCHIDSNPCH1CY202402272023.DOCX	Instruction
NTTCHIDSNPCH2CY202402272023.DOCX	Instruction
NTTCHIDSNPCH3CY202402272023.DOCX	Instruction
NTTCHIDSNPCH4CY202402272023.DOCX	Instruction
NTTCHIDSNPCH5CY202402272023.DOCX	Instruction
NTTCHIDSNPCH6CY202402272023.DOCX	Instruction
NTTCHIDSNPCH7CY202402272023.DOCX	Instruction
NTTCHIDSNPCH8CY202402272023.DOCX	Instruction
NTTCHIDSNPCH9CY202402272023.DOCX	Instruction
NTTCHIDSNPCH10CY202402272023.DOCX	Instruction
NTTCHIDSNPCH11CY202402272023.DOCX	Instruction
NTTCHIDSNPCH12CY202402272023.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: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.128 42 CFR 422.111

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	NTDSNPANOCCY20244122023_CS508Cleared.docx	No	Fillable Printable
Instruction	NTDSNPCH1CY20244122023_CS508Cleared.DOCX	No	Fillable Printable
Instruction	NTSPANDNSPCH2CY202402272023.DOCX	No	Fillable Printable
Instruction	NTDNSPCH3CY20244122023_CS508Cleared.docx	No	Fillable Printable
Instruction	NTDNSPCH4CY20244122023_CS508Cleared.DOCX	No	Fillable Printable
Instruction	NTDSNPCH5CY20244122023_CS508Cleared.DOCX	No	Fillable Printable
Instruction	NTSPANDSNPCH6CY202402272023.DOCX	No	Fillable Printable
Instruction	NTSPANDSNPCH7CY202402272023.DOCX	No	Fillable Printable
Instruction	NTSPANDSNPCH8CY202402272023.DOCX	No	Fillable Printable
Instruction	NTSPANDSNPCH9CY202402272023.DOCX	No	Fillable Printable
Instruction	NTDSNPCH10CY20244122023_CS508Cleared.DOCX	No	Fillable Printable
Instruction	NTSPANDSNPCH11CY202402272023.DOCX	No	Fillable Printable
Instruction	NTSPANDSNPCH12CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPANOCCY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH1CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH2CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH3CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH4CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH5CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH6CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH7CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH8CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH9CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH10CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH11CY202402272023.DOCX	No	Fillable Printable
Instruction	NTTCHIDSNPCH12CY202402272023.DOCX	No	Fillable Printable

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: 47

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	47	47
Annual IC Time Burden (Hours)	564	564
Annual IC Cost Burden (Dollars)	0	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.