Information Collection

Annual Reporting and Recordkeeping Requirements

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10476 MLR Report Workbook Annual Reporting and Recordkeeping Requirements	Form
Form CMS-10476 MLR Report Workbook Annual Reporting and Recordkeeping Requirements	Form
PRA Attachment C CY 2025 MLR Instructions_CLEAN_508check.pdf	Instruction
PRA Attachment C CY 2025 MLR Instructions_CLEAN_508check.pdf	Instruction
CMS-10476 MLR Report Workbook PRA Attachment B MLR Reporting Workbook_editable.xlsx www.cms.gov/files/zip/cy2018-mlr-workbook-and-instructionszip	Form
CMS-10476 MLR Report Workbook PRA Attachment B MLR Reporting Workbook_editable.xlsx www.cms.gov/files/zip/cy2018-mlr-workbook-and-instructionszip	Form
PRA Attachment C CY 2025 MLR Instructions_REDLINE.docx Track Change: MLR Report Filing Instructions	IC Document
PRA Attachment C CY 2025 MLR Instructions_REDLINE.docx Track Change: MLR Report Filing Instructions	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	No	Printable Only
Form	CMS-10476			https://www.cms.gov/files/zip/cy2018-mlr-workbook-and-instructionszip	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 660

Number of Respondents for Small Entity: 25

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	660	59	601
Annual IC Time Burden (Hours)	40,356	3,608	36,748
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Track Change: MLR Report Filing Instructions		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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