View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1210-0142	ICR Reference No: 202106-1210-002
Status: Historical Inactive	Previous ICR Reference No: 201902-1210-004
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Patient Protection and Affordable Care Act Patient Protection Notice
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 07/14/2021
	Date Received in OIRA: 07/13/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved	05/31/2022
Responses	734,800	0	734,800
Time Burden (Hours)	6,546	0	6,546
Cost Burden (Dollars)	4,005	0	4,005

Annual Cost to Federal Government: $0

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? No

Agency Contact: James Butikofer 202 693-8434 Butikofer.James@dol.gov

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