Creditable Coverage Disclosure To Cms On-line Form And Instructions : Cms-10198

CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS

OMB: 0938-1013

IC ID: 46152

Information Collection (IC) Details

View Information Collection (IC)

CREDITABLE COVERAGE DISCLOSURE TO CMS ON-LINE FORM AND INSTRUCTIONS : CMS-10198
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 423.56e

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10198 Creditable Coverage Disclosure to CMS Form CMS-10198 CC Disclosure to CMS Instructions and Screen Shots 2009-07-02.docx Yes Yes Paper Only

Health Health Care Services

 

86,560 8,000
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 86,560 0 0 -358,459 0 445,019
Annual IC Time Burden (Hours) 7,213 0 0 -28,389 0 35,602
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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