Patient Protection and Affordable Care Act Patient Protection Notice

ICR 201401-1210-003

OMB: 1210-0142

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2014-02-24
IC Document Collections
ICR Details
1210-0142 201401-1210-003
Historical Active 201011-1210-009
DOL/EBSA
Patient Protection and Affordable Care Act Patient Protection Notice
Extension without change of a currently approved collection   No
Regular
Approved without change 04/24/2014
Retrieve Notice of Action (NOA) 02/28/2014
  Inventory as of this Action Requested Previously Approved
04/30/2017 36 Months From Approved 04/30/2014
1,700,000 0 6,186,404
15,000 0 33,000
13,000 0 48,000

The Patient Protection Notice is used by health plan sponsors and issuers to notify certain individuals of their right to (1) choose a primary care provider or a pediatrician when a plan or issuer requires participants or subscribers to designate a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.

PL: Pub.L. 111 - 148 10101(g) Name of Law: Affordable Care Act
  
None

Not associated with rulemaking

  78 FR 71668 11/29/2013
79 FR 11467 02/28/2014
No

1
IC Title Form No. Form Name
Patient Protection and Affordable Care Act Patient Protection Notice

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,700,000 6,186,404 0 0 -4,486,404 0
Annual Time Burden (Hours) 15,000 33,000 0 0 -18,000 0
Annual Cost Burden (Dollars) 13,000 48,000 0 0 -35,000 0
No
No
This collection of information reflects a burden reduction due to the reduced number of impacted plans. Although this ICR may still impact plans in the future, the bulk of the burden associated occurred during the initial three year approval because this ICR only impacts plans which relinquish grandfathered status during the first year that they do so. As time goes on, most of the plans that intend to relinquish their grandfathered status will already have done so. The burden associated with continuing to provide this notice is factored into the estimates for the Summary Plan Description ICR (OMB Control Number 1210-0110).

$0
No
No
Yes
No
No
Uncollected
Chris Cosby 202 693-8540

  No

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.
02/28/2014


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