Transcription of CREDITABLE COVERAGE DISCLOSURE TO INSTRUCTIONS & …
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CREDITABLE COVERAGE DISCLOSURE TO INSTRUCTIONS & …
CENTERS FOR MEDICARE & MEDICAID SERVICES CREDITABLE COVERAGE DISCLOSURE TO CMS INSTRUCTIONS & SCREEN SHOTS Form Approved OMB No. 0938-1013 5/29/2012 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1013. The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review INSTRUCTIONS , search existing data resources, gather the data needed, and complete and review the information collection.
The determination of creditable coverage status does not require an attestation by a qualified actuary except for a benefit option(s) under a Group Health Plan for which an employer or union is electing the retiree drug subsidy.
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