Grandfathered Plan Change in Carrier Disclosure

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

OMB: 1210-0140

IC ID: 195225

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Grandfathered Plan Change in Carrier Disclosure
 
No New
 
Mandatory
 
29 CFR 2590.715-1251(a)(1)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Income Security General Retirement and Disability

 

110,000 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 110,000 0 110,000 0 0 0
Annual IC Time Burden (Hours) 1,800 0 1,800 0 0 0
Annual IC Cost Burden (Dollars) 124,000 0 124,000 0 0 0

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

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