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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
COBRA Notification Requirements--American Recovery and Reinvestment Act of 2009
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
29 CFR 2590.606(a)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other- ARRA Model COBRA Initial Election Notice
Final model general notice - full version.doc
Yes
No
Printable Only
Other-ARRA Model COBRA Supplemental Notice for Current Enrolles
Final model general notice - abbreviated version.doc
Yes
No
Printable Only
Other-ARRA Model COBRA Second Election Notice
Final model notice in connection with extended election periods.doc
Yes
No
Printable Only
Other-ARRA Model COBRA Notice for Non-ERISA Plans
Final model alternative notice.doc
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,500,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
22,877,000
0
0
0
0
22,877,000
Annual IC Time Burden (Hours)
0
0
0
0
0
0
Annual IC Cost Burden (Dollars)
16,112,734
0
0
0
0
16,112,734
Documents for IC
Title
Document
Date Uploaded
ARRA COBRA Model Notice Federal Register Notice
ARRA models FR notice 3-13-09.doc
03/13/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.