Information Collection Request
Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)
ICR 202311-0938-016 · OMB 0938-1164 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10418 Private Company for Disbursement of checks |
Form | Modified | Repair queued |
| Form CMS-10418 Annual MLR Report |
Form and Instruction | Modified | Repair queued |
 Comment Response Document.pdf |
Supplementary Document | Uploaded 2024-02-13 | Repair queued |
 MLR PRA Package Supporting Statement (002).docx |
Supporting Statement A | Uploaded 2024-02-13 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 201985 |  Retention of Records |
Modified | ||
| 201983 | Private Company for Disbursement of checks |
Form | Modified | |
| 201982 | Notice of rebates to Subscribers and Policyholders |
Other-Template | Modified | |
| 201981 | Annual MLR Report |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1164 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202011-0938-007 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |