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Federal forms, ICRs, and supporting documents

Information Collection

COBRA Notification Requirements--American Recovery and Reinvestment Act of 2009

IC 188172 under ICR 200908-1210-002 · OMB 1210-0123.

Documents and Forms
Document Name
Document Type
Other- ARRA Model COBRA Initial Elec
Other-ARRA Model COBRA Supplemental
Other-ARRA Model COBRA Second Electi
Other-ARRA Model COBRA Notice for No
IC Document
Information Collection (IC) Details

View Information Collection (IC)

COBRA Notification Requirements--American Recovery and Reinvestment Act of 2009
 
No Modified
 
Voluntary
 
29 CFR 2590.606(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-ARRA Model COBRA Second Election Notice Final model notice in connection with extended election periods.doc Yes No Printable Only
Other-ARRA Model COBRA Notice for Non-ERISA Plans Final model alternative notice.doc Yes No Printable Only
Other- ARRA Model COBRA Initial Election Notice Final model general notice - full version.doc Yes No Printable Only
Other-ARRA Model COBRA Supplemental Notice for Current Enrolles Final model general notice - abbreviated version.doc Yes No Printable Only

Income Security General Retirement and Disability

 

2,500,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 22,877,000 0 0 0 0 22,877,000
Annual IC Time Burden (Hours) 0 0 0 0 0 0
Annual IC Cost Burden (Dollars) 16,112,734 0 0 0 0 16,112,734

Title Document Date Uploaded
ARRA COBRA Model Notice Federal Register Notice ARRA models FR notice 3-13-09.doc 03/13/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.