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OMB Control No: 0938-1013	ICR Reference No: 202507-0938-007
Status: Received in OIRA	Previous ICR Reference No: 202103-0938-013
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	Date Submitted to OIRA: 07/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	141,400	0
Time Burden (Hours)	11,784	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	141,400	38,344	103,056
Annual Time Burden (Hours)	11,784	3,196	8,588
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The key revisions have been to update CMS estimates using the most recent data available. The estimate for the number of expected forms is based on actual data of the number of forms received and has increased since the last approval.

Annual Cost to Federal Government: $3,558

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