Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual MLR Report Modified 1897 119401 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
Notice of rebates to Subscribers and Policyholders Modified 7250812 65105 0
Private Company for Disbursement of checks Modified 1912240 47807 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 Modified 1897 114 0
Total burden requested under this ICR: 9166846 232427 0  
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