Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act of 1974 (ERISA)

ICR 200401-1210-001

OMB: 1210-0053

Federal Form Document

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Name
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No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1210-0053 200401-1210-001
Historical Active 200011-1210-001
DOL/EBSA
Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act of 1974 (ERISA)
Extension without change of a currently approved collection   No
Regular
Approved without change 02/23/2004
Retrieve Notice of Action (NOA) 01/23/2004
  Inventory as of this Action Requested Previously Approved
02/28/2007 02/28/2007 02/29/2004
18,000,000 0 118,000,000
336,200 0 316,000
90,582,000 0 95,637,000

ERISA Section 503 and regulations at 29 CFR 2560.503-1 require employee benefit plans to establish procedures for notification on claim denials, disclosure of reasons, and notice of opportunity to obtain a review of the denial.

None
None


No

1
IC Title Form No. Form Name
Employee Benefit Plan Claims Procedure 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 18,000,000 118,000,000 0 0 -100,000,000 0
Annual Time Burden (Hours) 336,200 316,000 0 0 20,200 0
Annual Cost Burden (Dollars) 90,582,000 95,637,000 0 0 -5,055,000 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.
01/23/2004


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