Coverage of Certain Preventive Services Under the Affordable Care Act

ICR 201412-1210-002

OMB: 1210-0150

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2015-02-27
Supplementary Document
2014-08-07
IC Document Collections
IC ID
Document
Title
Status
205659 Modified
ICR Details
1210-0150 201412-1210-002
Historical Active 201408-1210-005
DOL/EBSA
Coverage of Certain Preventive Services Under the Affordable Care Act
Extension without change of a currently approved collection   No
Regular
Approved without change 04/14/2015
Retrieve Notice of Action (NOA) 02/27/2015
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
61 0 122
51 0 51
33 0 33

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. The Departments issued interim final regulations in light of the Supreme Court's interim order in Wheaton College v. Burwell concerning notification to the Federal government that an eligible organization has a religious objection to providing contraceptive coverage, as an alternative to the EBSA Form 700, and to preserve participants' and beneficiaries' access to coverage for the full range of FDA-approved contraceptives, as prescribed by a health care provider, without cost sharing, which is also consistent with the Supreme Court's order. The interim final regulations amend the EBSA Form 700 ICR. The Department revised this ICR pursuant to the emergency PRA clearance procedures set forth under 5 CFR 1320.13 in order to implement the Supreme Court's order and make an alternative process for eligible organizations available as soon as possible. The Department is now requesting a full, three-year extension from OMB.

US Code: 29 USC 1185b Name of Law: Employee Retirement Income Security Act of 1974
  
None

Not associated with rulemaking

  79 FR 73629 12/11/2014
80 FR 10719 02/27/2015
Yes

1
IC Title Form No. Form Name
Self-Certification or Notiffication EBSA Form 700 Eligible Organization Self-Certification

  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 61 122 0 0 -61 0
Annual Time Burden (Hours) 51 51 0 0 0 0
Annual Cost Burden (Dollars) 33 33 0 0 0 0
No
No

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.
02/27/2015


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