Information Collection Request

Affordable Care Act Grandfathered Health Plan Disclosure, Recordkeeping Requirement, and Change in Carrier Disclosure

ICR 201011-1210-002 · OMB 1210-0140 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
195225 Grandfathered Plan Change in Carrier Disclosure New
193127 Grandfathered Plan Disclosoure and Recoredkeeping Requirement Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2013 36 Months From Approved 12/31/2010
56,457,000 0 56,347,000
1,077,800 0 323,000
561,000 0 437,000





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Grandfathered Plan Disclosoure and Recoredkeeping Requirement
Grandfathered Plan Change in Carrier Disclosure

table that charts list of burden
  Total Request 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 56,457,000 56,347,000 0 110,000 0 0
Annual Time Burden (Hours) 1,077,800 323,000 0 1,800 753,000 0
Annual Cost Burden (Dollars) 561,000 437,000 0 124,000 0 0


Reginfo record details
  No