View Information Collection (IC)

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					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					No		Fillable Fileable
Instruction					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: 712	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	712	0	-88	0	0	800
Annual IC Time Burden (Hours)	8,544	0	-1,056	0	0	9,600
Annual IC Cost Burden (Dollars)	726,582	0	-15,306	0	0	741,888

Documents for IC

Title	Document	Date Uploaded
HMO_MAPD_ANOC__Redline		02/12/2026
PPO_MAPD_ANOC__Redline		02/12/2026
DE_SNP_ANOC__Redline		02/12/2026
Cost_Plan_ANOC_Redline		02/12/2026
PFFS_ANOC__Redline		02/12/2026
MSA_ANOC_Redline		02/12/2026
HMO_MA_ANOC__Redline		02/12/2026
PPO_MA_ANOC_Redline		02/12/2026
PDP_ANOC_Redline		02/12/2026
HMO_MAPD_EOC_Redline		02/12/2026
PPO_MAPD_EOC_Redline		02/12/2026
DE_SNP_EOC_Redline		02/12/2026
Cost_Plan_EOC_Redline		02/12/2026
PFFS_EOC_Redline		02/12/2026
MSA_EOC_Redline		02/12/2026
HMO_MA_EOC_Redline		02/12/2026
PPO_MA_EOC_Redline		02/12/2026
PDP_EOC_Redline		02/12/2026

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

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