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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1210-0150
ICR Reference No:
201710-1210-001
Status:
Historical Active
Previous ICR Reference No:
201506-1210-002
Agency/Subagency:
DOL/EBSA
Agency Tracking No:
Title:
Coverage of Certain Preventive Services under the Affordable Care Act—Private Sector
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
10/13/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/13/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2018
6 Months From Approved
09/30/2018
Responses
274,629
0
61
Time Burden (Hours)
181
0
51
Cost Burden (Dollars)
68,662
0
33
Abstract:
Currently, the Departments are drafting interim final rules amending the Departments’ July 2015 final regulations to expand the exemption from providing contraceptive coverage to include additional entities (any kind of plan sponsor, health insurance issuer, or institution of higher education) and persons that object based on religious beliefs or moral convictions to contraceptive or sterilization coverage, and to make the accommodation compliance process optional for eligible organizations instead of a mandatory alternative to complying with the contraceptive coverage requirement. Under the interim final rules, entities currently using the accommodation may revoke their accommodation immediately. These rules leave in place HRSA’s discretion to continue to require contraceptive and sterilization coverage where no objection exists, and to the extent that PHS Act section 2713 otherwise applies. In an effort to consolidate the number of information collection requests, the Department is combining OMB control numbers 1210-0150 and 1210-0152 which will cover the private sector (for-profit and not-for-profit) . Once 1210-0150 is approved the Department will discontinue 1210-0152. Therefore, this emergency request for the EBSA Form 700 is a collection of information subject to the Paperwork Reduction Act under OMB Control Number 1210-0150 which is scheduled to expire on September 30, 2018.
Authorizing Statute(s):
US Code:
29 USC 1185b
Name of Law: Employee Retirement Income Security Act of 1974
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
1210-AB83
Final or interim final rulemaking
82 FR 47792
10/13/2017
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Notice of Availability of Separate Payments for Contraceptive Services
Notice of Revocation of Accommodation
Self-Certification or Notiffication
EBSA Form 700
Eligible Organization Self-Certification
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
274,629
61
0
274,568
0
0
Annual Time Burden (Hours)
181
51
0
130
0
0
Annual Cost Burden (Dollars)
68,662
33
0
68,629
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Changing Regulations
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Changes to the estimates reflect changes made to the regulation and an update of the estimates of entities that will take advantage of the increased flexibility of the exemption. The large increase in the number of notices is due mainly to employers now claiming exempt status providing participants and beneficiaries of the plans of the exemption and its effects. Also, burden that was formally under 1210-0152 is now included here.
Annual Cost to Federal Government:
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
Chris Cosby 202 693-8540
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
10/06/2017