Information Collection Request

Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)

ICR 202311-0938-016 · OMB 0938-1164 · Received in OIRA

Forms and Documents

Document Name	Status
Form CMS-10418 Private Company for Disbursement of checks Form	Modified
Form CMS-10418 Annual MLR Report Form and Instruction	Modified
Comment Response Document.pdf Supplementary Document	2024-02-13
MLR PRA Package Supporting Statement (002).docx Supporting Statement A	2024-02-13

IC Document Collections

IC ID	Document Title	Status
201985	Retention of Records	Modified
201983	Private Company for Disbursement of checks Form	Modified
201982	Notice of rebates to Subscribers and Policyholders Other-Template	Modified
201981	Annual MLR Report Form and Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-1164
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202011-0938-007
Agency Tracking No	CCIIO
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31