Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual MLR Report Modified 2442 151037 0 Form and Instruction CMS-10418 MLR Reporting Form
Form and Instruction CMS-10418 MLR Form Instructions
Instruction
Form CMS-10418 Risk Corridors Plan Level Form
Disbursement of Rebate Checks Modified 3272220 33365 0
Notice of Rebate to Enrollees Modified 640912 16023 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 2834 172 0
Total burden requested under this ICR: 3918408 200597 0  
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