Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual MLR Report Modified 2818 179278 0 Form and Instruction CMS-10418 MLR Reporting Form
Form and Instruction CMS-10418 MLR Form Instructions
Disbursement of Rebate Checks Modified 3704400 34375 0
Notice of Rebate to Enrollees Modified 859760 21494 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 2798 170 0
Total burden requested under this ICR: 4569776 235317 0  
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