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OMB Control No: 1210-0149	ICR Reference No: 201304-1210-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice to Employees of Coverage Options Under Fair Labor Standards Act Section 18B
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 04/26/2013
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/10/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/24/2013
Terms of Clearance: This information collection request is approved for 6 months. DOL will immediately begin the process of obtaining approval through the normal PRA process. DOL will also upload final documents via a nonsubstantive change request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	6 Months From Approved
Responses	72,484,292	0	0
Time Burden (Hours)	374,502	0	0
Cost Burden (Dollars)	12,229,992	0	0

Abstract: Section 18B of the FLSA, as added by section 1512 of the Affordable Care Act, generally provides that, in accordance with regulations promulgated by the Secretary of Labor, an applicable employer must provide each employee at the time of hiring (or with respect to current employees, not later than March 1, 2013), a written notice: 1. Informing the employee of the existence of Exchanges including a description of the services provided by the Exchanges, and the manner in which the employee may contact Exchanges to request assistance; 2. If the employer plan's share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit under section 36B of the Internal Revenue Code (the Code) if the employee purchases a qualified health plan through an Exchange; and 3. If the employee purchases a qualified health plan through an Exchange, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes. The model notice is being to provided by the Department to faciliate compliance with FLSA section 18B.

Emergency Justfication: On January 24, 2013, the Department issued guidance stating the Departments conclusion that the notice requirement under FLSA section 18B will not take effect on March 1, 2013 for several reasons. The Department explained that this notice should be coordinated with HHS's educational efforts and Internal Revenue Service (IRS) guidance on minimum value. The guidance also stated the Departments commitment to a smooth implementation process including providing employers with sufficient time to comply and selecting an applicability date that ensures employees receive the information at a meaningful time. The guidance further stated that the Department expects the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for the Marketplace. Subsequent to issuing the January 2013 guidance, the Department received unexpected requests from many employers for guidance and a model notice earlier than the summer or fall 2013 timeframe to allow them to inform their employees about the upcoming coverage options available through the Marketplace as soon as possible. In response to such requests, the Department is planning to issue a Technical Release providing temporary guidance regarding the notice requirement and a model notice by the end of April 2013. The model notice is a collection of information subject to the Paperwork Reduction Act. In accordance with 5 CFR 1320 and 5 CFR 1320.10, the Department is hereby requesting emergency clearance from OMB to issue the model notice immediately to ensure that approximately 72.5 million American workers are informed about their coverage options available under the Affordable Care Act as soon as possible and to facilitate compliance by the approximately 6.2 million employers that are required to provide the notice.

Authorizing Statute(s): US Code: 29 USC 218a Name of Law: Fair Labor Standards Act (FLSA)

Citations for New Statutory Requirements: US Code: 29 USC 218a Name of Law: Fair Labor Standards Act (FLSA)

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking
	Other Documents for OIRA Review

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Notice to Employees of Coverage Options under FLSA 18B

ICR Summary of Burden

	Total Approved	Change Due to New Statute
Annual Number of Responses	72,484,292	72,484,292
Annual Time Burden (Hours)	374,502	374,502
Annual Cost Burden (Dollars)	12,229,992	12,229,992

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection of information.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Christopher Cosby 202-693-8425 cosby.chris@dol.gov

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