Information Collection

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

IC 186438 under ICR 202304-0938-021 · OMB 0938-1051.

⚠️ Notice: This information collection may be referencing outdated material.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

2026-02-17 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HPMS User Guide Extract for CMS-10260.docx	Instruction
HPMS User Guide Extract for CMS-10260.docx	Instruction
CY2024_1_HMO_MAPD_ISNP_CSNP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_1_HMO_MAPD_ISNP_CSNP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_2_ PPO_MAPD_ISNP_CSNP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_2_ PPO_MAPD_ISNP_CSNP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_3_DE_SNP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_3_DE_SNP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_4_Cost Plan_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_4_Cost Plan_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_5_PFFS_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_5_PFFS_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_6_MSA_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_6_MSA_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_7_HMO MA_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_7_HMO MA_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_8_PPO MA_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_8_PPO MA_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_9_PDP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_9_PDP_ANOC_30 day PRA CLEAN.pdf	Instruction
CY2024_1_HMO_MAPD_ISNP_CSNP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_1_HMO_MAPD_ISNP_CSNP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_2_ PPO_MAPD_ISNP_CSNP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_2_ PPO_MAPD_ISNP_CSNP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_3_DE_SNP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_3_DE_SNP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_4_Cost Plan_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_4_Cost Plan_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_5_PFFS_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_5_PFFS_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_6_MSA_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_6_MSA_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_7_HMO MA_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_7_HMO MA_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_8_PPO MA_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_8_PPO MA_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_9_PDP_EOC_30 day PRA CLEAN.pdf	Instruction
CY2024_9_PDP_EOC_30 day PRA CLEAN.pdf	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:

CM-CPC

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	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: 800

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
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	800	5	795
Annual IC Time Burden (Hours)	9,600	60	9,540
Annual IC Cost Burden (Dollars)	741,888	-41,258,112	42,000,000

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.

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