View Information Collection (IC)

View Information Collection (IC)

IC Title:	Annual MLR Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 158

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10418	MLR Reporting Form	CMS-10418 - 2016-MLR-Reporting-Form-2017-07.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10418	MLR Form Instructions	CMS-10418 - 2016 MLR Form Instructions 2017-07.pdf		Yes	Yes	Fillable Fileable
Instruction			CMS-10418 - 2016-Risk-Corridor-Plan-Level-Instructions-x.pdf		Yes	Yes	Paper Only
Form	CMS-10418	Risk Corridors Plan Level Form	CMS-10418 - 2016-Risk-Corridors-Plan-Level-Form-x.xlsx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 545	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	2,442	0	0	0	0	2,442
Annual IC Time Burden (Hours)	151,037	0	0	0	0	151,037
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.