This information collection request is approved as submitted. However, DOL will evaluate the actual burden and number of respondents during this implementation period and will update the burden estimate accordingly via a nonsubstantive change request. Such update will occur no later than one year after this approval.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
08/31/2016
36 Months From Approved
2
0
0
2
0
0
1
0
0
The Information Collection requires plans established or maintained by certain religious employers (and group health insurance coverage provided in connection with such plans) claiming exemption to providing contraceptive service to self-certify that it meets the definition of an eligible organization. The eligible organization would provide its health insurance issuer or third party administrator with a copy of its self-certification.
The final regulations direct a third party administrator arranging or providing payments for contraceptive services at no cost to participants and beneficiaries in insured or self-insured plans (or student enrollees and covered dependents in student health insurance coverage) of eligible organizations to provide a written notice to such plan participants and beneficiaries (or such student enrollees and covered dependents) informing them of the availability of such payments. The notice must be provided contemporaneous with (to the extent possible) but separate from plan enrollment (or re-enrollment) materials, and must specify that contraceptive coverage will not be provided by the eligible organization but that the third party administrator will separately arrange or provide payments for contraceptive services, and must provide contact information for the third party administrator for questions and complaints. To satisfy the notice requirement, third party administrators may use the model language set forth in the final regulations or substantially similar language.
US Code:
29 USC 1185b
Name of Law: Employee Retirement Income Security Act of 1974
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form EBSA Form 700 Self-Certification
Contaception_Preventive_Care_SSfinal.docx
Self-Certification