Employee Benefit Plan Claim Procedures under the Employee Retirement Income Security Act of 1974 (ERISA)

ICR 199906-1210-001

OMB: 1210-0053

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1210-0053 199906-1210-001
Historical Active 199809-1210-021
DOL/EBSA
Employee Benefit Plan Claim Procedures under the Employee Retirement Income Security Act of 1974 (ERISA)
Reinstatement without change of a previously approved collection   No
Emergency 06/30/1999
Approved without change 07/02/1999
Retrieve Notice of Action (NOA) 06/23/1999
  Inventory as of this Action Requested Previously Approved
10/31/1999 10/31/1999
63,317,000 0 0
504,000 0 0
54,520,000 0 0

ERISA section 503 and regulations at 29 CFR 2560.603-1 require employee benefit plan to establish procedures for notification on claim denials, disclosure of reasons, and notice of opportunity to obtain review of the denial.

None
None


No

1
IC Title Form No. Form Name
Employee Benefit Plan Claim Procedures under the Employee Retirement Income Security Act of 1974 (ERISA)

  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 63,317,000 0 0 63,317,000 0 0
Annual Time Burden (Hours) 504,000 0 0 504,000 0 0
Annual Cost Burden (Dollars) 54,520,000 0 0 54,520,000 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.
06/23/1999


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