View Information Collection (IC)

View Information Collection (IC)

IC Title:	Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9812-1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,284,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 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	114,000	0	0	-109,200	0	223,200
Annual IC Time Burden (Hours)	5,988	0	4,088	0	0	1,900
Annual IC Cost Burden (Dollars)	256,000	0	256,000	0	0	0

Documents for IC

Title	Document	Date Uploaded
REG-120692-09	REG-120692-09.pdf	02/24/2016
TD 9479	TD 9479.pdf	02/24/2016
TD 9640	TD 9640.pdf	02/24/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.