Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824)

Forms and Documents

Document	Type	Status	Availability
CMS-10824_Supporting StatementA_.docx	Supporting Statement A	Uploaded 2025-12-16	Available
UHC Comments - State AIP EOC - 9_29_2025.pdf	Public Comments	Uploaded 2025-09-29	Repair queued
Kaiser Permanente.pdf	Public Comments	Uploaded 2025-11-29	Repair queued
Humana Comments on Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integra.docx	Public Comments	Uploaded 2025-09-26	Repair queued
ANOC-EOC instrument crosswalk 30-day 11.24.25.pdf	Supplementary Document	Uploaded 2025-12-11	Available
Summary of comments and responses 1.17.23_final.pdf	Supplementary Document	Uploaded 2023-02-03	Available
ANOC-EOC instrument crosswalk 60-day clean.pdf	Supplementary Document	Uploaded 2025-12-11	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
258292	Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)	Instruction	Modified

ICR Details

OMB Control No: 0938-1444	ICR Reference No: 202512-0938-015
Status: Received in OIRA	Previous ICR Reference No: 202302-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	109	47
Time Burden (Hours)	1,308	564
Cost Burden (Dollars)	0	0

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Abstract: This information collection request creates Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) templates for applicable integrated plans (AIPs), as defined at § 422.561, in certain States that chose to require these Medicare-Medicaid integrated templates.

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Authorizing Statute(s): US Code: 42 USC 1395w–21 Name of Law: Choice of medicare benefits through medicare+choice plan
   US Code: 42 USC 1395w-101 Name of Law: Provision of Qualified Prescription Drug Coverage Through Enrollment In Plans
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 36058	07/31/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58248	12/16/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	109	47	0	62	0	0
Annual Time Burden (Hours)	1,308	564	0	744	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden has increased due to an increase of 109 AIPs that will employ these models, which more than doubles our previous estimate. The number of AIPs has increased since 2023, when this package was last published. Because the number of AIPs has increased, the burden for completing the requirements in this package has increased in equal measure, by over 100 percent. CMS has also made small modifications to the models, however, these modifications have not affected burden, as many are non-substantive, and others are changes made on account of regulatory or administrative decisions for which the burden has been accounted for in different areas.

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Annual Cost to Federal Government: $29,558

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/16/2025

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