Information Collection Request

Notice Requirements of the Health Care Continuation Coverage Provisions

ICR 201002-1210-003 · OMB 1210-0123 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Justification for nonmaterial nonsubstantive change--COBRA Notices0312.doc Justification for No Material/Nonsubstantive Change Uploaded 2010-03-12 Available
Model Supplemental Information Notice 3 10 10.doc Supplementary Document Uploaded 2010-03-12 Available
Model Notice of Extended Election Period 3 10 10.doc Supplementary Document Uploaded 2010-03-12 Available
model New Election Period notice 3 10 10.doc Supplementary Document Uploaded 2010-03-12 Available
model General Notice 3 10 10.doc Supplementary Document Uploaded 2010-03-12 Available
model Alternative Notice 3 10 10.doc Supplementary Document Uploaded 2010-03-12 Repair queued

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2010 07/31/2010 07/31/2010
23,737,957 0 23,737,957
0 0 0
25,187,739 0 25,187,739





table that charts list 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 23,737,957 23,737,957 0 0 0 0
Annual Time Burden (Hours) 0 0 0 0 0 0
Annual Cost Burden (Dollars) 25,187,739 25,187,739 0 0 0 0


Reginfo record details
  No