OMB control number

Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824)

OMB 0938-1444 · HHS/CMS.

OMB 0938-1444

This information collection request creates Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) templates for applicable integrated plans (AIPs), as defined at § 422.561, in certain States that chose to require these Medicare-Medicaid integrated templates.

The latest form for Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824) expires 2026-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-10824_Supporting StatementA_.docx Supporting Statement A
ANOC-EOC instrument crosswalk 30-day 11.24.25.pdf Supplementary Document
Summary of comments and responses 1.17.23_final.pdf Supplementary Document
ANOC-EOC instrument crosswalk 60-day clean.pdf Supplementary Document
Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) Instruction

All Historical Document Collections

202512-0938-015	Revision of a currently approved collection	2025-12-16
202302-0938-006 Approved without change	New collection (Request for a new OMB Control Number)	2023-02-07