Information Collection

Establishing Creditable Coverage under Group Health Plans

IC 38420 under ICR 200609-1210-002 · OMB 1210-0103.

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IC Title:

Establishing Creditable Coverage under Group Health Plans

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.701-5 29 CFR 2520.104b-1

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: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,493,046

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	16,250,284	-4,749,716	21,000,000
Annual IC Time Burden (Hours)	75,306	-184,694	260,000
Annual IC Cost Burden (Dollars)	11,456,011	-7,043,989	18,500,000

Documents for IC

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