Annual Reporting and Recordkeeping Requirements

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

OMB: 0938-1232

IC ID: 209359

Information Collection (IC) Details

View Information Collection (IC)

Annual Reporting and Recordkeeping Requirements
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment C-CY 2023 MLR Reporting Instructions_final.docx Yes No Printable Only
Form CMS-10476 MLR Report Workbook Attachment B - CY2023 MLR Report Workbook_clean.pdf https://www.cms.gov/files/zip/cy2018-mlr-workbook-and-instructionszip Yes Yes Fillable Printable

Health Health Care Services

 

601 25
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 601 0 0 14 0 587
Annual IC Time Burden (Hours) 36,748 0 15,084 505 0 21,159
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change: MLR Report Filing Instructions Attachment C-CY 2023 MLR Reporting Instructions_redline (version 2).docx 09/26/2023
Track Change: MLR Report Workbook Attachment B - CY2023 MLR Report Workbook_redline (version 2).docx 09/26/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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