Affordable Care Act Enrollment Opportunity Notice Relating to Extension of Dependent Coverage

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SSPPACADepCov2010renewal.doc	Supporting Statement A	Uploaded 2010-12-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192671	Affordable Care Act Enrollment Opportunity Notice Relating to Extension of Dependent Coverage		Modified

ICR Details

OMB Control No: 1210-0139	ICR Reference No: 201011-1210-003
Status: Historical Active	Previous ICR Reference No: 201005-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Affordable Care Act Enrollment Opportunity Notice Relating to Extension of Dependent Coverage
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/21/2011
	Date Received in OIRA: 01/25/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	03/31/2011
Responses	79,573,000	0	79,573,000
Time Burden (Hours)	411,000	0	411,000
Cost Burden (Dollars)	1,233,500	0	1,233,500

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Abstract: The Department's Interim Final Regulation under the Patient Protection and Affordable Care Act (the Affordable Care Act)requires group health plans to provide a notice of an enrollment opportunity to individuals whose coverage ended, or who was denied coverage (or was not eligible for coverage) under a group health plan or group health insurance coverage because, under the terms of the plan or coverage, the availability of dependent coverage of children ended before the attainment of age 26. The enrollment opportunity must continue for at least 30 days, regardless of whether the plan or coverage offers an open enrollment period and regardless of when any open enrollment period might otherwise occur. This enrollment opportunity must be presented not later than the first day of the first plan year (or, in the individual market, policy year) beginning on or after September 23, 2010 (which is the applicability date of PHS Act sections 2714). Coverage must begin not later than the first day of the first plan year (or policy year in the individual market) beginning on or after September 23, 2010.

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Authorizing Statute(s): US Code: 29 USC 1186 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: US Code: 29 USC 1186 Name of Law: Employee Retirement Income Security Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 60482	09/30/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 4377	01/25/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Affordable Care Act Enrollment Opportunity Notice Relating to Extension of Dependent Coverage

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ICR Summary of Burden

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	79,573,000	79,573,000	0	0	0	0
Annual Time Burden (Hours)	411,000	411,000	0	0	0	0
Annual Cost Burden (Dollars)	1,233,500	1,233,500	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/25/2011

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