Information Collection

Notice Requirements of the Health Care Continuation Coverage Provisions

IC 13504 under ICR 201304-1210-012 · OMB 1210-0123.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0123 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Final Rule FedReg.pdf	Other-Final Rule
Deliberative_Document_Place_Holder.docx	Other-Deliberative Document

IC Title:

Notice Requirements of the Health Care Continuation Coverage Provisions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 2590

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Final Rule			Final Rule FedReg.pdf		Yes	Yes	Fillable Printable
Other-Deliberative Document			Deliberative_Document_Place_Holder.docx		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 649,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	15,662,333	15,662,333
Annual IC Time Burden (Hours)	503,815	503,815
Annual IC Cost Burden (Dollars)	20,217,778	20,217,778

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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