Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-Grandfathered Plans

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Appeals 2719 SS 10-6-2015.doc	Supporting Statement A	Uploaded 2015-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194302	Interim Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act	Other-Model	Modified
193842	Non-Grandfathered Group Health Plans Internal Claims and Appeals and External Review Processes		Modified

ICR Details

OMB Control No: 1210-0144	ICR Reference No: 201510-1210-008
Status: Historical Active	Previous ICR Reference No: 201507-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-Grandfathered Plans
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/04/2016
	Date Received in OIRA: 11/20/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	10/31/2018
Responses	278,413	0	276,000
Time Burden (Hours)	2,271	0	2,000
Cost Burden (Dollars)	1,143,236	0	1,100,000

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Abstract: This collection of information request includes the information collection and third party notice and disclosure requirements that a plan must satisfy under final regulations implementing provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review process.

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Authorizing Statute(s): US Code: 42 USC 300gg-19 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB72	Final or interim final rulemaking	80 FR 72192	11/18/2015

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 61903	10/15/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 43799	07/23/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Non-Grandfathered Group Health Plans Internal Claims and Appeals and External Review Processes
Interim Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act

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ICR Summary of Burden

table that charts list of burden

	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	278,413	276,000	0	0	2,413	0
Annual Time Burden (Hours)	2,271	2,000	0	0	271	0
Annual Cost Burden (Dollars)	1,143,236	1,100,000	0	0	43,236	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Because the final rule does not change the information collection requirements contained interim final regulations (and June 2011 amendment), most of the burden increase results from an increase in the number of non-grandfathered group health plans subject to the requirements of this information collection. A small portion also results from increases in wage rates and increases in postage rates.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/20/2015

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