Information Collection

Model Creditable Coverage Disclosure Notices (CMS-10182)

IC 45714 under ICR 200805-0938-003 · OMB 0938-0990.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0990 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10182 09.15.06 CC Guidance Updated Final - 09.12.06.doc	Instruction

IC Title:

Model Creditable Coverage Disclosure Notices (CMS-10182)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 423.56

Information Collection Instruments:

table that charts list of instruments
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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.