Calculation and Disclosure of Documentation of Eligibility for Exemption

ICR 199712-1210-002

OMB: 1210-0106

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
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ICR Details
1210-0106 199712-1210-002
Historical Active
DOL/EBSA
Calculation and Disclosure of Documentation of Eligibility for Exemption
New collection (Request for a new OMB Control Number)   No
Emergency 01/01/1998
Approved without change 12/30/1997
Retrieve Notice of Action (NOA) 12/22/1997
Approved with the condition that DOL will work to implement the information collection provisions of this rule in a way that minimizes burden.
  Inventory as of this Action Requested Previously Approved
08/31/1998 08/31/1998
3,527 0 0
117 0 0
2,430,000 0 0

The Mental Health Parity Act of 1996 requires parity between the dollar limits imposed on mental health benefits and those imposed on medical/surgical benefits offered by group health plans and group health insurance coverage issuers. Plans may elect an exemption from this requirement if parity would result in a cost increase of at least one percent and if participants and beneficiaries and the Federal Government are notified. Upon receipt of notice, participants and beneficiaries may request and receive at no charge a summary of the information on which the exemptions was based.

None
None


No

1
IC Title Form No. Form Name
Calculation and Disclosure of Documentation of Eligibility for Exemption

  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 3,527 0 0 3,527 0 0
Annual Time Burden (Hours) 117 0 0 117 0 0
Annual Cost Burden (Dollars) 2,430,000 0 0 2,430,000 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.
12/22/1997


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