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

ICR 202103-0938-013

OMB: 0938-1013

Federal Form Document

ICR Details
0938-1013 202103-0938-013
Received in OIRA 201702-0938-018
Creditable Coverage Disclosure to CMS OnLine Form and Instructions (CMS-10198)
Reinstatement without change of a previously approved collection   No
Regular 04/01/2021
  Requested Previously Approved
36 Months From Approved
103,056 0
8,588 0
0 0

Information collection requirements will ensure that entities that currently provide prescription drug benefits to any Medicare Part D eligible individual disclose to CMS whether the prescription drug benefit that they offer is creditable coverage. The disclosure is required to be provide annually and upon any change that affects whether the coverage is creditable prescription drug coverage. This collection also provides creditable coverage disclosure instructions for entities complying with these infromation collection request.

Statute at Large: 1 Stat. 1860

Not associated with rulemaking

  86 FR 1503 01/08/2021
86 FR 14753 03/18/2021

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 103,056 0 0 0 15,791 87,265
Annual Time Burden (Hours) 8,588 0 0 0 1,316 7,272
Annual Cost Burden (Dollars) 0 0 0 0 0 0
The key revisions have been to update our estimates using the most recent data available. For instance, the estimate for the number of expected forms is based on actual data of the number of forms we received last year. At five minutes a form, this totals 8,588 hours. Three years ago, the estimate for the number of forms was slightly lower, at 97,000, which at five minutes a form totaled about $7,000.

Stephan McKenzie 410 786-1943 [email protected]


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

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