Establishing Creditable Coverage

ICR 200003-1210-004

OMB: 1210-0103

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
13448
Migrated
ICR Details
1210-0103 200003-1210-004
Historical Active 199801-1210-002
DOL/EBSA
Establishing Creditable Coverage
Extension without change of a currently approved collection   No
Regular
Approved without change 06/15/2000
Retrieve Notice of Action (NOA) 03/30/2000
  Inventory as of this Action Requested Previously Approved
10/31/2003 10/31/2003 06/30/2000
44,396,000 0 8,000,000
351,150 0 336,060
34,689,000 0 31,800,000

After the submission of evidence establishing prior creditable coverage under a group health plan subsequent health insurance provider is limited in the extent to which it may use pre-existing condition exclusions to limit coverage. Pursuant to implementing rules at 29 CFR 2590.701-5, this ICR covers the requirement to provide information to participants sufficient to establish prior creditable coverage.

None
None


No

1
IC Title Form No. Form Name
Establishing Creditable Coverage

  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 44,396,000 8,000,000 0 0 36,396,000 0
Annual Time Burden (Hours) 351,150 336,060 0 0 15,090 0
Annual Cost Burden (Dollars) 34,689,000 31,800,000 0 0 2,889,000 0
No
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.
03/30/2000


© 2024 OMB.report | Privacy Policy