The agency is
not required to display the expiration date.
Inventory as of this Action
Requested
Previously Approved
06/30/2002
06/30/2002
07/31/1999
12,079,600
0
120,797,600
404,640
0
404,640
0
0
0
The statute and the regulations
require group health plans to provide notice to individuals who are
entitled to elect COBRA continuation coverage of their election
rights. Individuals who wish to obtain the benefits provided under
the statute are required to provide plans notices in the cases of
divorce from the covered employee, a dependent child's ceasing to
be dependent under the terms of the plan, and disability. Most
plans will require that elections of COBRA continuation coverage be
made in writing. In cases where qualified beneficiaries are short
by an insignificant amount in a payment made to the plan,
the....
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.