OMB control number

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

OMB 0938-1013 · HHS/CMS.

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 2028-12-31 and is listed under ICR 202507-0938-007.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10198 CC Form (screen shot)	Form
Form CMS-10198 Creditable Coverage Disclosure to CMS	Form and Instruction
Form CMS-10198 CC Form (screen shot) (document unavailable)	Form
Form CMS-10198 Creditable Coverage Disclosure to CMS	Form and Instruction
Form CMS-10198 CC Form (screen shot)	Form
Form CMS-10198 Creditable Coverage Disclosure to CMS	Form and Instruction
CMS-10198 - Supporting Statement A (CMS-4212-P version 7).docx	Supporting Statement A
State, Local, or Tribal Governments - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form
State, Local, or Tribal Governments - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction
State, Local, or Tribal Governments - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction
Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form
Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction
Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction
Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form
Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction
Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202602-0938-003	Revision of a currently approved collection	2026-02-12
202507-0938-007	Reinstatement without change of a previously approved collection	2025-07-16
202103-0938-013	Reinstatement without change of a previously approved collection	2021-04-01	Approved without change
201702-0938-018	Extension without change of a currently approved collection	2017-02-27	Approved with change
201604-0938-001	No material or nonsubstantive change to a currently approved collection	2016-04-05	Approved without change
201312-0938-006	Reinstatement with change of a previously approved collection	2013-12-06	Approved without change
200911-0938-003	Extension without change of a currently approved collection	2009-11-25	Approved without change
200706-0938-003	No material or nonsubstantive change to a currently approved collection	2007-06-12	Approved without change
200611-0938-010	New collection (Request for a new OMB Control Number)	2006-11-22	Approved without change

OMB Details

Federal - Creditable Coverage Disclosure to CMS OnLine Form and Instructions

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10198	Creditable Coverage Disclosure to CMS	Fillable Printable	Form and instruction
Form CMS-10198	CC Form (screen shot)	Fillable Printable	Form

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