Information Collection

Notice of Special Enrollment Rights under Group Health Plans

IC 38418 under ICR 200911-1210-001 · OMB 1210-0101.

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IC Title:	Notice of Special Enrollment Rights 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 2590.701-6 29 CFR 2520.104b-1

Information Collection 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: 2,757,800	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,847,611	2,279,329	8,568,282
Annual IC Time Burden (Hours)	0	-1	1
Annual IC Cost Burden (Dollars)	94,917	17,802	77,115

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