Information Collection

Notice Requirements of the Health Care Continuation Coverage Provisions

IC 13504 under ICR 201004-1210-004 · OMB 1210-0123.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0123 can be found here:

Documents and Forms

Document Name Document Type
Final Rule FedReg.pdf Other-Final Rule

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice Requirements of the Health Care Continuation Coverage Provisions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Final Rule			Final Rule FedReg.pdf		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 593,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,237,957	15,237,957
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	18,387,739	18,387,739

Documents for IC

Title	Document	Date Uploaded
No associated records found

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