OMB.report

Federal forms, ICRs, and supporting documents

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
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Information Collection (IC) Details

View Information Collection (IC)

Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) CM-CPC
 
No Modified
 
Mandatory
 
42 CFR 423.128(a)(3) 42 CFR 422.111(a)(3)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction HPMS User Guide Extract for CMS-10260.docx No   Fillable Fileable
Instruction CY2027_1_HMO_MAPD_ISNP_CSNP_ANOC_.docx No   Fillable Fileable
Instruction CY2027_2_PPO_MAPD_ISNP_CSNP_ANOC_.docx No   Fillable Fileable
Instruction CY2027_3_DE_SNP_ANOC_.docx No   Fillable Fileable
Instruction CY2027_4_Cost_Plan_ANOC_.docx No   Fillable Fileable
Instruction CY2027_5_PFFS_ANOC_.docx No   Fillable Fileable
Instruction CY2027_6_MSA_ANOC_.docx No   Fillable Fileable
Instruction CY2027_7_HMO_MA_ANOC_.docx No   Fillable Fileable
Instruction CY2027_8_PPO_MA_ANOC_.docx No   Fillable Fileable
Instruction CY2027_9_PDP_ANOC_.docx No   Fillable Fileable
Instruction CY2027_1_HMO_MAPD_ISNP_CSNP_EOC_.docx No   Fillable Fileable
Instruction CY2027_2_PPO_MAPD_ISNP_CSNP_EOC_.docx No   Fillable Fileable
Instruction CY2027_3_DE_SNP_EOC_.docx No   Fillable Fileable
Instruction CY2027_4_Cost_Plan_EOC_.docx No   Fillable Fileable
Instruction CY2027_5_PFFS_EOC_.docx No   Fillable Fileable
Instruction CY2027_6_MSA_EOC_.docx No   Fillable Fileable
Instruction CY2027_7_HMO_MA_EOC_.docx No   Fillable Fileable
Instruction CY2027_8_PPO_MA_EOC_.docx No   Fillable Fileable
Instruction CY2027_9_PDP_EOC_.docx No   Fillable Fileable

Health Health Care Services

 

712 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested 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 712 0 -88 0 0 800
Annual IC Time Burden (Hours) 8,544 0 -1,056 0 0 9,600
Annual IC Cost Burden (Dollars) 726,582 0 -15,306 0 0 741,888

Title Document Date Uploaded
HMO_MAPD_ANOC__Redline CY2027_1_HMO_MAPD_ANOC__Redline.docx 02/12/2026
PPO_MAPD_ANOC__Redline CY2027_2_PPO_MAPD_ANOC__Redline.docx 02/12/2026
DE_SNP_ANOC__Redline CY2027_3_DE_SNP_ANOC__Redline.docx 02/12/2026
Cost_Plan_ANOC_Redline CY2027_4_Cost_Plan_ANOC_Redline.docx 02/12/2026
PFFS_ANOC__Redline CY2027_5_PFFS_ANOC__Redline.docx 02/12/2026
MSA_ANOC_Redline CY2027_6_MSA_ANOC_Redline.docx 02/12/2026
HMO_MA_ANOC__Redline CY2027_7_HMO_MA_ANOC__Redline.docx 02/12/2026
PPO_MA_ANOC_Redline CY2027_8_PPO_MA_ANOC_Redline.docx 02/12/2026
PDP_ANOC_Redline CY2027_9_PDP_ANOC_Redline.docx 02/12/2026
HMO_MAPD_EOC_Redline CY2027_1_HMO_MAPD_EOC_Redline.docx 02/12/2026
PPO_MAPD_EOC_Redline CY2027_2_PPO_MAPD_EOC_Redline.docx 02/12/2026
DE_SNP_EOC_Redline CY2027_3_DE_SNP_EOC_Redline.docx 02/12/2026
Cost_Plan_EOC_Redline CY2027_4_Cost_Plan_EOC_Redline.docx 02/12/2026
PFFS_EOC_Redline CY2027_5_PFFS_EOC_Redline.docx 02/12/2026
MSA_EOC_Redline CY2027_6_MSA_EOC_Redline.docx 02/12/2026
HMO_MA_EOC_Redline CY2027_7_HMO_MA_EOC_Redline.docx 02/12/2026
PPO_MA_EOC_Redline CY2027_8_PPO_MA_EOC_Redline.docx 02/12/2026
PDP_EOC_Redline CY2027_9_PDP_EOC_Redline.docx 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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