Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions Modified 30 3 0 Form and Instruction CMS-10198 Creditable Coverage Disclosure to CMS
Form CMS-10198 CC Form (screen shot)
Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions Modified 102977 8581 0 Form and Instruction CMS-10198 Creditable Coverage Disclosure to CMS
Form CMS-10198 CC Form (screen shot)
State, Local, or Tribal Governments - Creditable Coverage Disclosure to CMS OnLine Form and Instructions Modified 49 4 0
Total burden requested under this ICR: 103056 8588 0  
To view an IC, click on IC Title