Notice of Pre-Existing Condition Exclusion

ICR 199704-1210-003

OMB: 1210-0102

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
13442
Migrated
ICR Details
1210-0102 199704-1210-003
Historical Active
DOL/EBSA
Notice of Pre-Existing Condition Exclusion
New collection (Request for a new OMB Control Number)   No
Emergency 06/01/1997
Approved without change 05/30/1997
Retrieve Notice of Action (NOA) 04/08/1997
These information collection requirements are granted an emergency 6-month approval pursuant to the Paperwork Reduction Act under the following conditions: 1) in the preamble the final rule and in the next PRA submission, HHS, DoL, and Treasury respond in writing and in more detail to the concerns expressed in public comment received by OMB and forwarded to the agencies on these information requirements; 2) in the context of the final rule and as part of the next PRA submission, the Departments continue to evaluate the burden imposed by these requirements upon the health insurance industry and employers, in particular the burden of providing certificates of dependency coverage. The final rulemaking and next PRA submission must reflect the Departments' analysis, based on all available feedback from plans and employers, of the actual comprehensive burden imposed and other relevant implementation factors.
  Inventory as of this Action Requested Previously Approved
03/31/1998 03/31/1998
90,470 0 0
1,235 0 0
75,000 0 0

Pursuant to 29 CFR 2590.701-3(c), a group health plan offering group health insurance coverage may not impose any pre-existing condition exclusions on a participant unless the participant has been notified of the plan's provisions and his or her right to establish prior creditable coverage. 29 CFR 2590.701-4 requires that plans that use the alternative method of crediting coverage disclose their method at the time of a participant's enrollment in the plan. 29 CFR 2590.701-5(d) requires that before a plan imposes a pre-existing condition exclusion on a particular participant, it must first disclose that....

None
None


No

1
IC Title Form No. Form Name
Notice of Pre-Existing Condition Exclusion

  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 90,470 0 0 90,470 0 0
Annual Time Burden (Hours) 1,235 0 0 1,235 0 0
Annual Cost Burden (Dollars) 75,000 0 0 75,000 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/08/1997


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