View Information Collection (IC)
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)
Agency IC Tracking Number:
CM-CPC
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 423.128(a)(3)
42 CFR 422.111(a)(3)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
HPMS User Guide Extract for CMS-10260.docx
No
Fillable Fileable
Instruction
CY2021_Clean_1_HMO_MAPD_ISNP_CSNP_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_2_PPO_MAPD_ISNP_CSNP_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_3_DE_SNP_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_4_Cost_Plan_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_5_PFFS_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_6_MSA_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_7_HMO_MA_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_8_PPO_MA_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_9_PDP_ANOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_1_HMO_MAPD_ISNP_CSNP_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_2_PPO_MAPD_ISNP_CSNP_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_3_DE_SNP_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_4_Cost_Plan_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_5_PFFS_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_6_MSA_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_7_HMO_MA_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_8_PPO_MA_EOC_03162020.docx
No
Fillable Fileable
Instruction
CY2021_Clean_9_PDP_EOC_03162020.docx
No
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:
795
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
795
0
0
-10
0
805
Annual IC Time Burden (Hours)
9,540
0
0
-120
0
9,660
Annual IC Cost Burden (Dollars)
42,000,000
0
0
-8,026,730,000
0
8,068,730,000
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.
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