Notice of Pre-Existing Condition Exclusion Under Group Health Plans

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HIPAA 1210-0102ss06.doc	Supporting Statement A	Uploaded 2006-10-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45340	Individual Notice of Preexisting Condition Exclusion under Group Health Plans		New
38419	General Notice of Pre-Existing Condition Exclusion Under Group Health Plans		Modified

ICR Details

OMB Control No: 1210-0102	ICR Reference No: 200608-1210-002
Status: Historical Active	Previous ICR Reference No: 200412-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice of Pre-Existing Condition Exclusion Under Group Health Plans
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/01/2006
	Date Received in OIRA: 10/16/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	11/30/2006
Responses	3,832,337	0	2,700,000
Time Burden (Hours)	5,714	0	2,289
Cost Burden (Dollars)	1,120,709	0	272,000

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Abstract: Under 29 CFR 2590.701-3(c), a group health plan may not impose a pre-existing condition exclusion on a participant unless the participant has been notified of the plan's provisions regarding the right to establish prior creditable coverage. Section 2590.701-5(d) also requires that plans inform a participant in writing of any determination to impose a pre-existing condition exclusion against him or her.

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Authorizing Statute(s): US Code: 29 USC 1181 Name of Law: ERISA (as revised by HIPAA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 41055	07/19/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 60756	10/16/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
General Notice of Pre-Existing Condition Exclusion Under Group Health Plans
Individual Notice of Preexisting Condition Exclusion under Group Health Plans

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ICR Summary of Burden

table that charts list of burden

	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	3,832,337	2,700,000	0	0	1,132,337	0
Annual Time Burden (Hours)	5,714	2,289	0	0	3,425	0
Annual Cost Burden (Dollars)	1,120,709	272,000	0	0	848,709	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no program changes to this ICR since the last submission of an 83-C Change Worksheet in 2004. The Department has updated the number of plans (respondents) based on more recent information and has revised its methods for determining number of responses, which has caused in increase in that number and a corresponding increase in the hour burden. The assumptions for costs (wage rates, postage, etc.) have also been updated, causing an increase in the annual cost burden.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/16/2006

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