Information Collection

Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions

IC 46152 under ICR 201604-0938-001 · OMB 0938-1013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10198 Creditable Coverage Disclosure to CMS Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction
CMS-10198 Creditable Coverage Disclosure to CMS CC Disclosure to CMS Instructions and Screen Shots Clean 0938-1013 CMS 10198final.pdf	Form and Instruction
Crosswalk.xlsx Crosswalk	IC Document

Record metadata
IC Title	Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions