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OMB Control No: 1210-0150	ICR Reference No: 201705-1210-001
Status: Historical Inactive	Previous ICR Reference No: 201506-1210-002
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Coverage of Certain Preventive Services under the Affordable Care Act—Private Sector
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 10/12/2017
OIRA Conclusion Action: Preapproved	Conclusion Date: 10/12/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/06/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	6 Months From Approved	09/30/2018
Responses	274,629	0	61
Time Burden (Hours)	181	0	51
Cost Burden (Dollars)	68,662	0	33

Abstract: Currently, the Departments are drafting interim final rules amending the Departments’ July 2015 final regulations to expand the exemption from providing contraceptive coverage to include additional entities (any kind of plan sponsor, health insurance issuer, or institution of higher education) and persons that object based on religious beliefs or moral convictions to contraceptive or sterilization coverage, and to make the accommodation compliance process optional for eligible organizations instead of a mandatory alternative to complying with the contraceptive coverage requirement. Under the interim final rules, entities currently using the accommodation may revoke their accommodation immediately. These rules leave in place HRSA’s discretion to continue to require contraceptive and sterilization coverage where no objection exists, and to the extent that PHS Act section 2713 otherwise applies. In an effort to consolidate the number of information collection requests, the Department is combining OMB control numbers 1210-0150 and 1210-0152 which will cover the private sector (for-profit and not-for-profit) . Once 1210-0150 is approved the Department will discontinue 1210-0152. Therefore, this emergency request for the EBSA Form 700 is a collection of information subject to the Paperwork Reduction Act under OMB Control Number 1210-0150 which is scheduled to expire on September 30, 2018.

Emergency Justfication: Department submits the revised information collection request to OMB for the following reasons: (1) public harm is reasonably likely to ensue if the normal clearance procedures are followed; (2) the use of normal clearance procedures is reasonably likely to prevent or disrupt the collection of information, because newly exempt entities that wish to opt into the amended accommodation process might not be able to do so until normal clearance procedures are completed.; and (3) the use of normal clearance procedures is reasonably likely to cause a statutory or court ordered deadline to be missed. Many cases have been on remand for over a year from the Supreme Court asking the Departments and the parties to resolve this matter.

Authorizing Statute(s): US Code: 29 USC 1185b Name of Law: Employee Retirement Income Security Act of 1974

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB83	Final or interim final rulemaking

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Notice of Availability of Separate Payments for Contraceptive Services
Notice of Revocation of Accommodation
Self-Certification or Notiffication	EBSA Form 700

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	274,629	61	274,568
Annual Time Burden (Hours)	181	51	130
Annual Cost Burden (Dollars)	68,662	33	68,629

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes to the estimates reflect changes made to the regulation and an update of the estimates of entities that will take advantage of the increased flexibility of the exemption. The large increase in the number of notices is due mainly to employers now claiming exempt status providing participants and beneficiaries of the plans of the exemption and its effects. Also, burden that was formally under 1210-0152 is now included here.

Annual Cost to Federal Government:

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]? Yes

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: Chris Cosby 202 693-8540

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