View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1013
ICR Reference No:
202103-0938-013
Status:
Historical Active
Previous ICR Reference No:
201702-0938-018
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CM-CPC
Title:
Creditable Coverage Disclosure to CMS OnLine Form and Instructions (CMS-10198)
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/02/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/01/2021
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2025
36 Months From Approved
Responses
103,056
0
0
Time Burden (Hours)
8,588
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Information collection requirements will ensure that entities that currently provide prescription drug benefits to any Medicare Part D eligible individual disclose to CMS whether the prescription drug benefit that they offer is creditable coverage. The disclosure is required to be provide annually and upon any change that affects whether the coverage is creditable prescription drug coverage. This collection also provides creditable coverage disclosure instructions for entities complying with these infromation collection request.
Authorizing Statute(s):
Statute at Large:
1 Stat. 1860
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
86 FR 1503
01/08/2021
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 14753
03/18/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions
CMS-10198, CMS-10198
Creditable Coverage Disclosure to CMS
,
CC Form (screen shot)
Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions
CMS-10198, CMS-10198
Creditable Coverage Disclosure to CMS
,
CC Form (screen shot)
State, Local, or Tribal Governments - Creditable Coverage Disclosure to CMS OnLine Form and Instructions
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
103,056
0
0
0
15,791
87,265
Annual Time Burden (Hours)
8,588
0
0
0
1,316
7,272
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The key revisions have been to update our estimates using the most recent data available. For instance, the estimate for the number of expected forms is based on actual data of the number of forms we received last year. At five minutes a form, this totals 8,588 hours. Three years ago, the estimate for the number of forms was slightly lower, at 97,000, which at five minutes a form totaled about $7,000.
Annual Cost to Federal Government:
$2,693
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/01/2021
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