Information Collection

Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)

IC 186438 under ICR 202602-0938-010 · OMB 0938-1051.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HPMS User Guide Extract for CMS-10260.docx	Instruction
CY2027_1_HMO_MAPD_ISNP_CSNP_ANOC_.docx	Instruction
CY2027_2_PPO_MAPD_ISNP_CSNP_ANOC_.docx	Instruction
CY2027_3_DE_SNP_ANOC_.docx	Instruction
CY2027_4_Cost_Plan_ANOC_.docx	Instruction
CY2027_5_PFFS_ANOC_.docx	Instruction
CY2027_6_MSA_ANOC_.docx	Instruction
CY2027_7_HMO_MA_ANOC_.docx	Instruction
CY2027_8_PPO_MA_ANOC_.docx	Instruction
CY2027_9_PDP_ANOC_.docx	Instruction
CY2027_1_HMO_MAPD_ISNP_CSNP_EOC_.docx	Instruction
CY2027_2_PPO_MAPD_ISNP_CSNP_EOC_.docx	Instruction
CY2027_3_DE_SNP_EOC_.docx	Instruction
CY2027_4_Cost_Plan_EOC_.docx	Instruction
CY2027_5_PFFS_EOC_.docx	Instruction
CY2027_6_MSA_EOC_.docx	Instruction
CY2027_7_HMO_MA_EOC_.docx	Instruction
CY2027_8_PPO_MA_EOC_.docx	Instruction
CY2027_9_PDP_EOC_.docx	Instruction
CY2027_1_HMO_MAPD_ANOC__Redline.docx HMO_MAPD_ANOC__Redline	IC Document
CY2027_2_PPO_MAPD_ANOC__Redline.docx PPO_MAPD_ANOC__Redline	IC Document
CY2027_3_DE_SNP_ANOC__Redline.docx DE_SNP_ANOC__Redline	IC Document
CY2027_4_Cost_Plan_ANOC_Redline.docx Cost_Plan_ANOC_Redline	IC Document
CY2027_5_PFFS_ANOC__Redline.docx PFFS_ANOC__Redline	IC Document
CY2027_6_MSA_ANOC_Redline.docx MSA_ANOC_Redline	IC Document
CY2027_7_HMO_MA_ANOC__Redline.docx HMO_MA_ANOC__Redline	IC Document
CY2027_8_PPO_MA_ANOC_Redline.docx PPO_MA_ANOC_Redline	IC Document
CY2027_9_PDP_ANOC_Redline.docx PDP_ANOC_Redline	IC Document
CY2027_1_HMO_MAPD_EOC_Redline.docx HMO_MAPD_EOC_Redline	IC Document
CY2027_2_PPO_MAPD_EOC_Redline.docx PPO_MAPD_EOC_Redline	IC Document
CY2027_3_DE_SNP_EOC_Redline.docx DE_SNP_EOC_Redline	IC Document
CY2027_4_Cost_Plan_EOC_Redline.docx Cost_Plan_EOC_Redline	IC Document
CY2027_5_PFFS_EOC_Redline.docx PFFS_EOC_Redline	IC Document
CY2027_6_MSA_EOC_Redline.docx MSA_EOC_Redline	IC Document
CY2027_7_HMO_MA_EOC_Redline.docx HMO_MA_EOC_Redline	IC Document
CY2027_8_PPO_MA_EOC_Redline.docx PPO_MA_EOC_Redline	IC Document
CY2027_9_PDP_EOC_Redline.docx PDP_EOC_Redline	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)

Agency IC Tracking Number:

CM-CPC

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.128(a)(3) 42 CFR 422.111(a)(3)

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable
Instruction	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 712

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	712	-88	800
Annual IC Time Burden (Hours)	8,544	-1,056	9,600
Annual IC Cost Burden (Dollars)	726,582	-15,306	741,888

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMO_MAPD_ANOC__Redline		02/12/2026
PPO_MAPD_ANOC__Redline		02/12/2026
DE_SNP_ANOC__Redline		02/12/2026
Cost_Plan_ANOC_Redline		02/12/2026
PFFS_ANOC__Redline		02/12/2026
MSA_ANOC_Redline		02/12/2026
HMO_MA_ANOC__Redline		02/12/2026
PPO_MA_ANOC_Redline		02/12/2026
PDP_ANOC_Redline		02/12/2026
HMO_MAPD_EOC_Redline		02/12/2026
PPO_MAPD_EOC_Redline		02/12/2026
DE_SNP_EOC_Redline		02/12/2026
Cost_Plan_EOC_Redline		02/12/2026
PFFS_EOC_Redline		02/12/2026
MSA_EOC_Redline		02/12/2026
HMO_MA_EOC_Redline		02/12/2026
PPO_MA_EOC_Redline		02/12/2026
PDP_EOC_Redline		02/12/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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