Information Collection Request
Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)
ICR 202305-0938-009 · OMB 0938-1232 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1232 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 CMS-10476 - Supporting Statement A (CMS-4192-F version 4).docx |
Supporting Statement A | Uploaded 2023-05-24 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 209359 |  Annual Reporting and Recordkeeping Requirements |
Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1232 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202006-0938-003 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |