CMS-10198 CC Form (screen shot)

Creditable Coverage Disclosure to CMS OnLine Form and Instructions (CMS-10198)

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1013 can be found here:

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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Tammie Wall
File Modified	0000-00-00
File Created	2021-01-21