Individual Notice of Preexisting Condition Exclusion under Group Health Plans

Notice of Pre-Existing Condition Exclusion Under Group Health Plans

OMB: 1210-0102

IC ID: 45340

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Individual Notice of Preexisting Condition Exclusion under Group Health Plans
 
No Modified
 
Mandatory
 
29 CFR 2590.701-3 29 CFR 2590.701-4

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

Health Health Care Services

 

685,114 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 575,411 0 0 -853,847 0 1,429,258
Annual IC Time Burden (Hours) 3,452 0 0 -836 0 4,288
Annual IC Cost Burden (Dollars) 731,390 0 0 -134,373 0 865,763

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