Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual MLR Report Modified 1843 106314 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 4200368 38824 0 Other-Template
Other-Template
Other-Template
Private Company for Disbursement of checks Modified 994046 24851 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 1675 101 0
Total burden requested under this ICR: 5197932 170090 0  
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