Notice of Special Enrollment Rights under Group Health Plans

Forms and Documents

Document	Type	Status	Availability
HIPAA 1210-0101ss06.doc	Supporting Statement A	Uploaded 2006-10-03	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
38418	Notice of Special Enrollment Rights under Group Health Plans		Modified

ICR Details

OMB Control No: 1210-0101	ICR Reference No: 200609-1210-001
Status: Historical Active	Previous ICR Reference No: 200412-1210-002
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice of Special Enrollment Rights 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:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	11/30/2006
Responses	8,568,282	0	9,200,000
Time Burden (Hours)	1	0	1
Cost Burden (Dollars)	77,115	0	77,000

---

Abstract: Under 29 CFR 2590.701-6(c), a group health plan must provide an individual who is offered coverage under the plan a notice describing the plan's special enrollment rights at or before the time coverage is offered. If the individual declines coverage, and a "special enrollment" event, such as loss of other coverage due to the death or termination of a spouse's employment, legal separation or divorce, occurs, the plan must offer special enrollment to the individual.

---

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

Citations for New Statutory Requirements: None

---

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

---

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

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Notice of Special Enrollment Rights under Group Health Plans

---

ICR Summary 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	8,568,282	9,200,000	0	0	-631,718	0
Annual Time Burden (Hours)	1	1	0	0	0	0
Annual Cost Burden (Dollars)	77,115	77,000	0	0	115	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 have been no program changes to this ICR since the last submission of an 83-C Change Worksheet in 2004. The annual number of plans (respondents) have been updated (reduced) based on current information as have the assumptions regarding costs (wage rates, postage, etc.), which have risen. In addition, the Department has revised its methods of determining how many plans are likely to be respondents and how long it will take to provide the responses, based on the nature of the obligation to respond, which reduced the number of respondents for this ICR. The overall effect of these adjustments is to reduce the number of respondents, but increase the burden estimates.

---

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

---

Common Form ICR:  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:

(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

---