Model Creditable Coverage Disclosure Notices (CMS-10182)

Model Creditable Coverage Disclosure Notices

OMB: 0938-0990

IC ID: 8852

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-10182 CC-Track change
Other-CMS 10182 NC-Track Changes
Other-CC Guidance
Other-CC Guidance Track Changes
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10182 NC-SP Aviso Importante de [Inserte el Nombre de la Entidad] Sobre su Cobertura para Recetas M?dicas y Medicare CMS_10182NC_Spanish_7_31_08.doc Yes Yes Paper Only
Form and Instruction CMS-10182 CC-SP Aviso Importante de [Inserte el Nombre de la Entidad] Sobre su Cobertura para Recetas M?dicas y Medicare CMS_10182CC_Spanish_7_31_08.doc Yes Yes Paper Only
Form and Instruction CMS-10182 NC Important Notice from [Insert Name of Entity] About PRA CC disclosure - Updated 06.06.08 for 02 01 09.doc Yes Yes Paper Only
Other-10182 CC-Track change PRA CC disclosure TRK- Updated 03.13.08 for 02 01 09.doc Yes Yes Paper Only
Form and Instruction CMS-10182 NC Important Notice From [Insert Name of Entity] About PRA Non-CC disclosure - Updated 06.06.08 for 02 01 09.(2).doc Yes Yes Paper Only
Other-CMS 10182 NC-Track Changes PRA Non-CC disclosure TRK - Updated 04.23.08 for 02 01 09.doc Yes Yes Paper Only
Other-CC Guidance CC Guidance - Fed PRA - Updated 06 06 08 for 02 01 09.(2).doc Yes Yes Paper Only
Other-CC Guidance Track Changes CC Guidance - Fed PRA TRK - Updated 04.23.08 for 02 01 09.(2).doc Yes Yes Paper Only

Health Health Care Services

 

444,613 37,697
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 1,186,268 0 0 3,597 0 1,182,671
Annual IC Time Burden (Hours) 513,772 0 0 5,223 0 508,549
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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