Information Collection

Non-Grandfathered Group Health Plans Internal Claims and Appeals and External Review Processes

IC 193842 under ICR 201105-1210-001 · OMB 1210-0144.

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Information Collection (IC) Details

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IC Title:	Non-Grandfathered Group Health Plans Internal Claims and Appeals and External Review Processes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.715-2719

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,020,374	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	111,328	49,525	61,803
Annual IC Time Burden (Hours)	233	-30	263
Annual IC Cost Burden (Dollars)	628,863	386,035	242,828

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