Establishing Creditable Coverage under Group Health Plans

Forms and Documents

Document Name	Status
HIPAA 1210-0103ss06.doc Supporting Statement A	2006-10-04

IC Document Collections

IC ID	Document Title	Status
38420	Establishing Creditable Coverage under Group Health Plans	Modified

ICR Details

OMB Control No: 1210-0103	ICR Reference No: 200609-1210-002
Status: Historical Active	Previous ICR Reference No: 200412-1210-003
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Establishing Creditable Coverage 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	16,250,284	0	21,000,000
Time Burden (Hours)	75,306	0	260,000
Cost Burden (Dollars)	11,456,011	0	18,500,000

---

Abstract: This ICR covers information collections arising out of rules at 29 CFR 2590.701-5 that provide guidance on the information that group health plans must provide to individuals about their "creditable coverage" (the length of time they have been continuously covered under the plan). Such individuals may use the information, provided in "certificates of creditable coverage" after their coverage under the plan has ended, to establish their right not to have a subsequent plan impose a preexisting condition exclusion against them.

---

Authorizing Statute(s): US Code: 29 USC 1181 Name of Law: ERISA (as 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
Establishing Creditable Coverage 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	16,250,284	21,000,000	0	0	-4,749,716	0
Annual Time Burden (Hours)	75,306	260,000	0	0	-184,694	0
Annual Cost Burden (Dollars)	11,456,011	18,500,000	0	0	-7,043,989	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 Department has updated the estimates of respondents (plans) and responses, as well as the assumptions relating to cost (e.g., wage rates and postage). In addition, the Department has revised its methods for estimating the numbers of responses that will be required under the information collection requirements. These changes have resulted in a reduction in the numbers of responses, and a corresponding reduction in the overall burden of this information collection.

---

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

---