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: 1210-0053	ICR Reference No: 202001-1210-001
Status: Historical Active	Previous ICR Reference No: 201611-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/06/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/26/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	04/30/2020
Responses	1,465,526,748	0	311,790,227
Time Burden (Hours)	1,627,422	0	516,227
Cost Burden (Dollars)	1,959,351,534	0	814,449,932

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,465,526,748	311,790,227	1,153,736,521
Annual Time Burden (Hours)	1,627,422	516,227	1,111,195
Annual Cost Burden (Dollars)	1,959,351,534	814,449,932	1,144,901,602

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: The increased burden is due to a correction in the estimate of the burden to include post-service approved claims in the burden estimate of the number of notices. A review of FAQs issued by the agency highlighted that approved claims still could be an adverse determination if 100 percent of the claim was not paid (even if in-line with plan requirements due to co-pays, deductibles, and other cost-sharing arrangements). The adverse determination would require notice, which often occurs in the form of an explanation of benefits (EOBs).

Annual Cost to Federal Government: $0

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]? No

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: James Butikofer 202 693-8434 Butikofer.James@dol.gov