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
Other-SBC template-April 2017 http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Fillable Fileable
Instruction http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-SBC Sample Glossary http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-SBC Yes Answers -- Why This Matters http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-SBC - No Answers - Why This Matters http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Template http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Template http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Template http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Instruction http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Narrative http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Narrative http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Narrative http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-SBC template- 2012 http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Fillable Fileable
Instruction http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-SBC Yes Answers--Why This Matters http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-No Answers- Why This Matters http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Template http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Fillable Printable
Other-Template http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Fillable Printable
Other-Narrative http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Narrative http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Instruction http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Printable Only
Other-Coverage Calculator http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Fillable Printable
Other-Coverage Calculator http://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html Yes No Fillable Printable

Health Consumer Health and Safety

 

2,299,742 2,158,601
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   38 %

  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 68,686,125 0 0 8,038,784 0 60,647,341
Annual IC Time Burden (Hours) 414,335 0 0 42,471 0 371,864
Annual IC Cost Burden (Dollars) 8,478,862 0 0 991,078 0 7,487,784

Title Document Date Uploaded
Sample Completed SBC 04/04/2016
Sample Completed SBC 04/04/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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