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 is listed under ICR 202512-0938-015.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 CMS-10824_Supporting StatementA_.docx | Supporting Statement A |
 UHC Comments - State AIP EOC - 9_29_2025.pdf | Public Comments |
| Kaiser Permanente.pdf | 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202512-0938-015 | Revision of a currently approved collection | 2025-12-16 | ||
| 202302-0938-006 | New collection (Request for a new OMB Control Number) | 2023-02-07 | Approved without change |