Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS : CMS-10198 Modified 7 37 0 Form CMS-10198 DIsclosure to CMS Web Page
Instruction
Form CMS-10198 Disclosure to CMS Form
Instruction
CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS : CMS-10198 Modified 5634 1916 0 Form CMS-10198 DIsclosure to CMS Web Page
Instruction
Form CMS-10198 Disclosure to CMS Form
Instruction
CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS : CMS-10198 Modified 445019 35602 0 Form CMS-10198 DIsclosure to CMS Web Page
Instruction
Form CMS-10198 Disclosure to CMS Form
Instruction
Total burden requested under this ICR: 450660 37555 0  
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