Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual MLR Report Modified 3394 212361 0 Form and Instruction CMS-10418 MLR Reporting Form
Form and Instruction CMS-10418 MLR Form Instructions
Disbursement of Rebate Checks Modified 1151040 19017 0
Notice of Rebate to Enrollees Modified 5709045 40223 0 Form and Instruction CMS-10418 MLR Notice 1 - Individual Market to Subscribers
Form and Instruction CMS-10418 MLR Notice 2 Group Markets - Rebate to Policyholder
Form and Instruction CMS-10418 MLR Notice 3 - Group Markets - Rebate to Subscribers
Form and Instruction CMS-10418 MLR Notice Instructions
Retention of Records Modified 517 200 0
Total burden requested under this ICR: 6863996 271801 0  
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