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Federal forms, ICRs, and supporting documents

Information Collection

Annual Reporting and Recordkeeping Requirements

IC 209359 under ICR 202605-0938-005 · OMB 0938-1232.

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

View Information Collection (IC)

Annual Reporting and Recordkeeping Requirements
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction PRA Attachment C CY 2025 MLR Instructions_CLEAN_508check.pdf Yes No Printable Only
Form CMS-10476 MLR Report Workbook PRA Attachment B MLR Reporting Workbook_editable.xlsx https://www.cms.gov/files/zip/cy2018-mlr-workbook-and-instructionszip Yes Yes Fillable Printable

Health Health Care Services

 

660 25
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 660 0 0 59 0 601
Annual IC Time Burden (Hours) 40,356 0 0 3,608 0 36,748
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change: MLR Report Filing Instructions PRA Attachment C CY 2025 MLR Instructions_REDLINE.docx 05/11/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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