On February 4, 2009, President Obama
signed the Children's Health Insurance Program Reauthorization Act
of 2009 (CHIPRA, Pub. L. 111-3). Under ERISA section
701(f)(3)(B)(i)(I), PHS Act section 2701(f)(3)(B)(i)(I), and
section 9801(f)(3)(B)(i)(I) of the Internal Revenue Code, as added
by CHIPRA, an employer that maintains a group health plan in a
State that provides medical assistance under a State Medicaid plan
under title XIX of the Social Security Act (SSA), or child health
assistance under a State child health plan under title XXI of the
SSA, in the form of premium assistance for the purchase of coverage
under a group health plan, is required to make certain disclosures.
Specifically, the employer is required to notify each employee of
potential opportunities currently available in the State in which
the employee resides for premium assistance under Medicaid and CHIP
for health coverage of the employee or the employee's dependents.
ERISA section 701(f)(3)(B)(i)(II) requires the Department of Labor
to provide employers with model language for the Employer CHIP
Notice to enable them to timely comply with this requirement. The
model is required to include information on how an employee may
contact the State in which the employee resides for additional
information regarding potential opportunities for premium
assistance, including how to apply for such assistance. Section
311(b)(1)(D) of CHIPRA provides that the Departments of Labor and
Health and Human Services shall develop the initial Model Employer
CHIP Notices under ERISA section 701(f)(3)(B)(i)(II), and the
Department of Labor shall provide such notices to employers, by
February 4, 2010. Moreover, each employer is required to provide
the initial annual notices to such employer's employees beginning
with the first plan year that begins after the date on which the
initial model notices are first issued. The ICR relates to the
Model Employer Chip Notice.
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.
no material change statement CHIP.docx
CHIPRA model notice ss 13.doc
Model Employer CHIP Notice (State, Local, Tribal Governmental Burden)