Information Collection

Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

IC 191431 under ICR 201211-1210-005 · OMB 1210-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0138 can be found here:

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Information Collection (IC) Details

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IC Title:	Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.712(d)(2)

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: 420,400	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: 38 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	420,400	-25,600	446,000
Annual IC Time Burden (Hours)	900	-50	950
Annual IC Cost Burden (Dollars)	569,614	7,114	562,500

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