Information Collection

Notice Requirements of the Health Care Continuation Coverage Provisions

IC 13504 under ICR 200406-1210-001 · OMB 1210-0123.

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IC Title:

Notice Requirements of the Health Care Continuation Coverage Provisions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of 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: 411,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,225,900	9,225,900
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	16,400,000	16,400,000

Documents for IC

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Title	Document	Date Uploaded

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