Information Collection Request

Coverage of Certain Preventive Services Under the Affordable Care Act-For-Profit Entities

ICR 201408-1210-003 · OMB 1210-0152 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form EBSA Form 700 Self-Certification or Notification Form New Available
1210-0NEWss(20140827).docx Supporting Statement A Uploaded 2014-08-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
212710 Self-Certification or Notification Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Self-Certification or Notification EBSA Form 700 Eligible Organization Self-Certification



Reginfo record details
  No