Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual MLR Report Unchanged 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 Unchanged 3272220 33365 0
Notice of Rebate to Enrollees Modified 640912 16848 0 Form CMS-10418 MLR Notice 1 - Individual Market to Subscribers
Form CMS-10418 MLR Notice 2 Group Markets - Rebate to Policyholder
Form CMS-10418 MLR Notice 3 - Group Markets - Rebate to Subscribers
Instruction
Form CMS-10418 MLR Notice Individual Market to Subscribers Optional B
Retention of Records Unchanged 2834 172 0
Total burden requested under this ICR: 3918408 201422 0  
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