View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Summary of Benefits and Coverage
 
No Modified
 
Mandatory
 
29 CFR 2590.715-2715

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form New Summary of Benefits and Coverage (SBC) Template 2715_Deliberative_Document[(20120207).docx Yes Yes Fillable Printable
Instruction 2715_Deliberative_Document[(20120207).docx Yes Yes Paper Only
Instruction 2715_Deliberative_Document[(20120207).docx Yes Yes Paper Only
Other-Model 2715_Deliberative_Document[(20120207).docx Yes Yes Paper Only
Other-Model 2715_Deliberative_Document[(20120207).docx Yes Yes Paper Only
Other-Model 2715_Deliberative_Document[(20120207).docx Yes Yes Paper Only

Health Consumer Health and Safety

 

858 274
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   44 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 77,000,000 77,000,000 0 0 0 0
Annual IC Time Burden (Hours) 602,750 602,750 0 0 0 0
Annual IC Cost Burden (Dollars) 4,150,000 4,150,000 0 0 0 0

Title Document Date Uploaded
Sample Completed SBC-Individual Health Insurance Coverage 2715_Deliberative_Document[(20120207).docx 02/07/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.