Information Collection

Notice of Pre-Existing Condition Exclusion Under ERISA

IC 13445 under ICR 200306-1210-008 · OMB 1210-0102.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Notice of Pre-Existing Condition Exclusion Under ERISA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8,570,000	8,570,000
Annual IC Time Burden (Hours)	9,004	9,004
Annual IC Cost Burden (Dollars)	1,088,000	1,088,000

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.