Model Creditable Coverage Disclosure Notices (CMS-10182)

Model Creditable Coverage Disclosure Notices

OMB: 0938-0990

IC ID: 45715

Information Collection (IC) Details

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Model Creditable Coverage Disclosure Notices (CMS-10182)
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 423.56

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-10182 09.15.06 CC Guidance Updated Final - 09.12.06.doc Yes Yes Printable Only
Form CMS 10182-P Important Notice from[Insert Name of Enity] About Your Prescription Drug Coverage and Medicare CMS-10182 09.15.06 PRA CC disclosure Updated 09.12.06.DOC Yes Yes Printable Only
Form CMS 10182-CC Individual Creditable Coverage Disclosure Notice CMS-10182 09.15.06 PRA CC disclosure Updated 09.12.06.DOC Yes Yes Printable Only
Form CMS 10182-NC Individual Non-Creditable Coverage Disclosure Notice CMS-10182 09.15.06 PRA Non-CC disclosure Updated 09.12.06.DOC Yes Yes Printable Only

Health Health Care Services

 

5,540 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 42,436 0 42,436 0 0 0
Annual IC Time Burden (Hours) 13,580 0 13,580 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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