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CMS-10198 CC Form (screen shot)
Creditable Coverage Disclosure to CMS OnLine Form and Instructions (CMS-10198)
CCOnlinePageView
Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions
OMB: 0938-1013
OMB.report
HHS/CMS
OMB 0938-1013
ICR 202103-0938-013
IC 46151
CMS-10198 CC Form (screen shot)
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Author
Tammie Wall
File Modified
2021-01-05
File Created
2021-01-05
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