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

OMB 0938-1013

OMB 0938-1013

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.

The latest form for Creditable Coverage Disclosure to CMS OnLine Form and Instructions (CMS-10198) expires 2020-12-31 and can be found here.

OMB Details

Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10198Creditable Coverage Disclosure to CMSFillable PrintableForm and instruction
Form CMS-10198CC Form (screen shot)Fillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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