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 10 1 0 Form and Instruction CMS-10198 Creditable Coverage Disclosure to CMS Form
CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS : CMS-10198 Modified 930 78 0
CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS : CMS-10198 Modified 86560 7213 0 Form and Instruction CMS-10198 Creditable Coverage Disclosure to CMS Form
Total burden requested under this ICR: 87500 7292 0  
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