View Information Collection Request (ICR) Package

OMB Control No: 0970-0222	ICR Reference No: 202302-0970-005
Status: Historical Active	Previous ICR Reference No: 202211-0970-008
Agency/Subagency: HHS/ACF	Agency Tracking No: OCSE
Title: National Medical Support Notice - Part A
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/03/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/03/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2025	11/30/2025	11/30/2025
Responses	9,746,434	0	9,746,434
Time Burden (Hours)	1,656,939	0	1,656,939
Cost Burden (Dollars)	0	0	0

Abstract: OMB approved the NMSN Part for an additional three years with an expiration date of November 30, 2025. OMB also approved OCSE’s request to extend the prior NMSN Part A until 10/31/2023 to allow states to program the revisions to Part A. The Office of Child Support Enforcement developed the NMSN Part A as a standard, required form for child support enforcement agencies to use to ensure dependent children are enrolled in available employer-sponsored medical coverage, if required by a support order. The form was developed with input from employer groups and health plan administrators, and complies with section 609 (a)(3) and (4) of the Employee Retirement Income Security Act of 1974 (ERISA), which pertains to informational requirements and restrictions against requiring new types of forms for benefits. The recently approved NMSN Part A and Part A sample have only one line for users to provide information in the “last known address” field. While creating a PDF to properly capture the information, OCSE needed to add additional and separate lines to the last known address field. OCSE requests OMB approve these minor changes to the NMSN Part A and the Part A Sample. The information collected complies with section 401 of the Child Support Performance and Incentives Act of 1998 (CSPIA), which requires state child support agencies, under title IV-D of the Social Security Act, (the Act), to enforce health care coverage provided in a child support order and section 609 of the Employee Retirement Income Security Act of 1974 (ERISA), which deems the NMSN the enforcement mechanism for the medical support requirement. The laws require the NMSN to be promulgated by regulations issued jointly by the Departments of Health and Human Services (HHS) and Labor (DOL). The collection activities associated with the NMSN are further authorized by (1) 42 U.S.C. § 666, which requires all child support orders to include a provision for medical support and where appropriate, enforced through the use of the National Medical Support Notice; (2) 29 U.S.C. § 1169, which provides for medical coverage pursuant to a qualified medical support order. This nonsub request is to make modifications to the recently approved NMSN Part A and Part A sample. Past versions have only one line for users to provide information in the “last known address” field. While creating a PDF to properly capture the information, OCSE needed to add additional and separate lines to the last known address field pg. 3 on Part A and Part A Sample.

Authorizing Statute(s): US Code: 29 USC 1169 Name of Law: Additional standards for group health plans
   US Code: 45 USC 303.32 Name of Law: National Medical Support Notice
   PL: Pub.L. 105 - 200 401(c) Section 609 Name of Law: Child Support Performance and Incentive Act
   US Code: 42 USC 666 Name of Law: Requirement of statutorily prescribed procedures to improve effectiveness of child supp enforcement

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:
	87 FR 26762	05/05/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 57701	09/21/2022
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	9,746,434	9,746,434
Annual Time Burden (Hours)	1,656,939	1,656,939
Annual Cost Burden (Dollars)	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:

Annual Cost to Federal Government: $183,727

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. Yes

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]? No

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: Molly Buck 202 205-4724 mary.buck@acf.hhs.gov

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