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Federal forms, ICRs, and supporting documents

Information Collection

Annual MLR Report

IC 201981 under ICR 202311-0938-016 · OMB 0938-1164.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Annual MLR Report
 
No Modified
 
Mandatory
 
45 CFR 158

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10418 MLR Reporting Form 2022-MLR-Reporting-Form-PRA.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10418 MLR Form Instructions 2022 MLR Form Instructions.pdf Yes Yes Fillable Fileable
Instruction CMS-10418 - 2016-Risk-Corridor-Plan-Level-Instructions-x.pdf Yes Yes Paper Only
Form CMS-10418 Risk Corridors Plan Level Form CMS-10418 - 2016-Risk-Corridors-Plan-Level-Form-x.xlsx Yes Yes Fillable Fileable

Health Health Care Services

 

480 0
   
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 1,843 0 0 -54 0 1,897
Annual IC Time Burden (Hours) 106,314 0 0 -13,087 0 119,401
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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