OMB control number

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

OMB 0938-1444 · HHS/CMS.

OMB 0938-1444

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.

The latest form for Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824) expires 2029-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-10824_Supporting StatementA_.docx Supporting Statement A
UHC Comments - State AIP EOC - 9_29_2025.pdf (document unavailable) Public Comments
Kaiser Permanente.pdf (document unavailable) Public Comments
Humana Comments on Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integra.docx (document unavailable) Public Comments
ANOC-EOC instrument crosswalk 30-day 11.24.25.pdf Supplementary Document
Summary of comments and responses 1.17.23_final.pdf Supplementary Document
ANOC-EOC instrument crosswalk 60-day clean.pdf Supplementary Document
Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) Instruction

All Historical Document Collections

202512-0938-015	Revision of a currently approved collection	2025-12-16
202302-0938-006 Approved without change	New collection (Request for a new OMB Control Number)	2023-02-07