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OMB Control No: 0938-1013	ICR Reference No: 202608-0938-021
Status: Received in OIRA	Previous ICR Reference No: 202602-0938-003
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: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/27/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2028
Responses	134,351	141,400
Time Burden (Hours)	11,152	11,784
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	134,351	141,400	-7,049
Annual Time Burden (Hours)	11,152	11,784	-632
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This iteration is associated with our April 6, 2026 (91 FR 17384) Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program final rule (CMS-4212-F; RIN 0938-AV63). The rule estimates that about 5 percent of the 140,974 Group Health Plans (7,049 account-based medical plans) (140,974 plans x 0.05) will no longer be required to provide creditable coverage disclosure. The result is a decrease of 632 hours Our active 0.083 hr/response time estimate is unchanged. We are not proposing any changes to the active Creditable Coverage Disclosure to CMS Form.

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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