View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
1210-0101
ICR Reference No:
200609-1210-001
Status:
Historical Active
Previous ICR Reference No:
200412-1210-002
Agency/Subagency:
DOL/EBSA
Agency Tracking No:
Title:
Notice of Special Enrollment Rights under Group Health Plans
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:
12/01/2006
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/16/2006
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2009
36 Months From Approved
11/30/2006
Responses
8,568,282
0
9,200,000
Time Burden (Hours)
1
0
1
Cost Burden (Dollars)
77,115
0
77,000
Abstract:
Under 29 CFR 2590.701-6(c), a group health plan must provide an individual who is offered coverage under the plan a notice describing the plan's special enrollment rights at or before the time coverage is offered. If the individual declines coverage, and a "special enrollment" event, such as loss of other coverage due to the death or termination of a spouse's employment, legal separation or divorce, occurs, the plan must offer special enrollment to the individual.
Authorizing Statute(s):
US Code:
29 USC 1181
Name of Law: ERISA (revised by HIPAA)
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
71 FR 41055
07/19/2006
30-day Notice:
Federal Register Citation:
Citation Date:
71 FR 60756
10/16/2006
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 of Special Enrollment Rights under Group Health Plans
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
8,568,282
9,200,000
0
0
-631,718
0
Annual Time Burden (Hours)
1
1
0
0
0
0
Annual Cost Burden (Dollars)
77,115
77,000
0
0
115
0
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:
There have been no program changes to this ICR since the last submission of an 83-C Change Worksheet in 2004. The annual number of plans (respondents) have been updated (reduced) based on current information as have the assumptions regarding costs (wage rates, postage, etc.), which have risen. In addition, the Department has revised its methods of determining how many plans are likely to be respondents and how long it will take to provide the responses, based on the nature of the obligation to respond, which reduced the number of respondents for this ICR. The overall effect of these adjustments is to reduce the number of respondents, but increase the burden estimates.
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]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Susan Lahne 202 693-8500
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:
10/16/2006
An official website of the United States government
The .gov means it's official.
The site is secure.
