Data is used by the Agency, other Federal, State and local agencies and the private sector to monitor and perform research on the topic of employer sponsor health insurance. Data from this survey supports calculation of Gross domestic product by the Bureau of Economic Analysis. Respondents are all public and private sector employers in the United States.
US Code:
42 USC 299b-2
Name of Law: Health Care Quality Act of 1999
Overall, annual estimated burden hours will increase by 7.6 percent, compared to the 2008-2009 clearance. A slight decrease in burden due to fewer respondents for all forms will be offset by an increase in the number of expected plan forms to be completed per respondent (from an average 1.6 to 2.1), based on results from prior years.
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:
(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;
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.
Form Form #3 Plan Questionnaire
OMB Memo.doc
ATTACHMENT B -- 60 Day FR Notice.pdf
Plan Questionnaire