View Information Collection (IC)
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Agenda
Reg Review
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:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 423.128
42 CFR 422.111
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
ANOC.docx
No
Fillable Printable
Instruction
CH 1 EOC.docx
No
Fillable Printable
Instruction
CH 2 EOC.docx
No
Fillable Printable
Instruction
Ch 3 EOC.docx
No
Fillable Printable
Instruction
CH 4 EOC.docx
No
Fillable Printable
Instruction
CH 5 EOC.docx
No
Fillable Printable
Instruction
CH 6 EOC.docx
No
Fillable Printable
Instruction
CH 7 EOC.docx
No
Fillable Printable
Instruction
CH 8 EOC.docx
No
Fillable Printable
Instruction
CH 9 EOC.docx
No
Fillable Printable
Instruction
CH 10 EOC.docx
No
Fillable Printable
Instruction
CH 11 EOC.docx
No
Fillable Printable
Instruction
CH 12 EOC.docx
No
Fillable Printable
Instruction
NTTCHIDSNPANOCCY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH1CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH2CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH3CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH4CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH5CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH6CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH7CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH8CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH9CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH10CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH11CY202402272023.DOCX
No
Fillable Printable
Instruction
NTTCHIDSNPCH12CY202402272023.DOCX
No
Fillable Printable
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:
109
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
109
0
62
0
0
47
Annual IC Time Burden (Hours)
1,308
0
744
0
0
564
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ANOC Track Change version
NT ANOC compare 06182025.docx
12/11/2025
Ch. 1 Track Change version
CH 1 compare 06162025.docx
12/11/2025
Ch. 2 Track Change version
CH 2 compare 06162025.docx
12/11/2025
Ch. 3 Track Change version
Ch 3 compare 06162025.docx
12/11/2025
Ch. 4 Track Change version
CH 4 compare 06162025.docx
12/11/2025
Ch. 5 Track Change version
CH 5 compare 06162025.docx
12/11/2025
Ch. 6 Track Change version
CH 6 compare 06122025.docx
12/11/2025
Ch. 7 Track Change version
CH 7 compare 06122025.docx
12/11/2025
Ch. 8 Track Change version
CH 8 compare 06122025.docx
12/11/2025
Ch. 9 Track Change version
CH 9 compare 06122025.docx
12/11/2025
Ch. 10 Track Change version
CH 10 compare 06122025.docx
12/11/2025
Ch. 11 Track Change version
CH 11 compare 06122025.docx
12/11/2025
Ch. 12 Track Change version
CH 12 compare 06122025.docx
12/11/2025
Appendix A (added to ANOC)
Appendix A.docx
12/11/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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