CMS-10198 CC Form (screen shot)
Creditable Coverage Disclosure to CMS OnLine Form and Instructions (CMS-10198)
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Private Sector - Creditable Coverage Disclosure to CMS OnLine Form and Instructions
OMB: 0938-1013
⚠️ Notice: This form may be outdated.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/pdf |
| Author | Tammie Wall |
| File Modified | 2021-01-05 |
| File Created | 2021-01-05 |