View Information Collection Request (ICR) Package
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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:
1210-0137
ICR Reference No:
201001-1210-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
DOL/EBSA
Agency Tracking No:
Title:
Model Employer CHIP Notice
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
01/19/2010
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/26/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/05/2010
Terms of Clearance:
DOL will begin the process of getting this collection approved under the normal process of the PRA and will consider any information obtained by use of the notice during this 6 month period, as well as public comments to improve the practical utility of the disclosure and reduce its burden.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2010
6 Months From Approved
Responses
203,795,000
0
0
Time Burden (Hours)
1,053,000
0
0
Cost Burden (Dollars)
25,271,000
0
0
Abstract:
On February 4, 2009, President Obama signed the Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA, Pub. L. 111-3). Under ERISA section 701(f)(3)(B)(i)(I), PHS Act section 2701(f)(3)(B)(i)(I), and section 9801(f)(3)(B)(i)(I) of the Internal Revenue Code, as added by CHIPRA, an employer that maintains a group health plan in a State that provides medical assistance under a State Medicaid plan under title XIX of the Social Security Act (SSA), or child health assistance under a State child health plan under title XXI of the SSA, in the form of premium assistance for the purchase of coverage under a group health plan, is required to make certain disclosures. Specifically, the employer is required to notify each employee of potential opportunities currently available in the State in which the employee resides for premium assistance under Medicaid and CHIP for health coverage of the employee or the employees dependents. ERISA section 701(f)(3)(B)(i)(II) requires the Department of Labor to provide employers with model language for the Employer CHIP Notice to enable them to timely comply with this requirement. The model is required to include information on how an employee may contact the State in which the employee resides for additional information regarding potential opportunities for premium assistance, including how to apply for such assistance. Section 311(b)(1)(D) of CHIPRA provides that the Departments of Labor and Health and Human Services shall develop the initial Model Employer CHIP Notices under ERISA section 701(f)(3)(B)(i)(II), and the Department of Labor shall provide such notices to employers, by February 4, 2010. Moreover, each employer is required to provide the initial annual notices to such employers employees beginning with the first plan year that begins after the date on which the initial model notices are first issued. The ICR relates to the Model Employer Chip Notice.
Emergency Justfication:
On February 4, 2009, President Obama signed the Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA, Pub. L. 111-3). CHIPRA includes a requirement that the Departments of Labor (the Department) and Health and Human Services (HHS) develop a model notice for employers to use to inform employees of potential opportunities currently available in the State in which the employee resides for group health plan premium assistance under Medicaid and the Childrens Health Insurance Program (CHIP). CHIPRA requires the Department to provide the model notice to employers by February 4, 2010. Emergency Request and Justification: EBSA is hereby requesting that OCIO approve its request to submit the CHIPRA model notice (model notice) information collection request (ICR) to OMB under the emergency Paperwork Reduction Act (PRA) procedures set for in 5 CFR 1320.13. As stated above, the Department is required to issue the model notice by February 4, 2010, and use of the normal PRA clearance procedures is likely to cause the statutory deadline to be missed. The Department collaborated extensively with the states regarding the model notice. On August 5, 2009, the Department and HHS held an all-states call with State Medicaid & CHIP Directors to discuss the notice requirements under section 311 of CHIPRA and receive initial feedback on the development of the notice. After the call, the Agencies developed a draft template for the model notice, and on September 24, 2009, the model notice was sent to the State representative for feedback on the text of the notice itself, as well as verification of each states CHIP and Medicaid office contact information. Comments were due by October 9, 2009, and written comments were received from about half of the states, and three states provided feedback directly to HHS over the phone. The Departments considered all comments that were received, and the model notice reflects many of the comments.
Authorizing Statute(s):
PL:
Pub.L. 111 - 3 311(b)(1)(D)
Name of Law: Children's Health Insurance Program Reauthorization Act of 2009
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 3 311(b)(1)(D) Name of Law: Children's Health Insurance Program Reauthorization Act of 2009
US Code: 29 USC 1181(f)(3)(B)(i)(II) Name of Law: Employee Retirement Income Security Act of 1974
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
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
Model Employer CHIP Notice
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
203,795,000
0
203,795,000
0
0
0
Annual Time Burden (Hours)
1,053,000
0
1,053,000
0
0
0
Annual Cost Burden (Dollars)
25,271,000
0
25,271,000
0
0
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:
New third-party disclosure requirement pursuant to the Children's Health Insurance Program Reauthorization Act of 2009.
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)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Christopher Cosby 202-693-8425 cosby.chris@dol.gov
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:
01/05/2010
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