Summary of Benefits and Coverage and Uniform Glossary Required Under the Affordable Care Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
accessible-maternity-scenario-2012.pdf	Supplementary Document	Uploaded 2016-04-04	Available
diabetes-scenario-2012.pdf	Supplementary Document	Uploaded 2016-04-04	Available
SBC Completed Template - 2012.doc	Supplementary Document	Uploaded 2016-04-04	Available
SBC Sample CompletedApril 2017.doc	Supplementary Document	Uploaded 2016-04-04	Available
Simple fracture April 2017.pdf	Supplementary Document	Uploaded 2016-04-04	Available
Managing Type 2 Diabetes April 2017.pdf	Supplementary Document	Uploaded 2016-04-04	Available
Having a baby April 2017.pdf	Supplementary Document	Uploaded 2016-04-04	Available
SBC Response to Comments April 2017.docx	Supplementary Document	Uploaded 2016-04-05	Available
SBC Response to Comments April 2017.docx	Supplementary Document	Uploaded 2016-04-05	Available
SBC DOL PRA supporting statement 3-31-2016.docx	Supporting Statement A	Uploaded 2016-04-04	Available
FAQs Part XIV 4-23-13 10am final.docx	Supplementary Document	Uploaded 2013-04-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198891	Modifications		Modified
198890	Glossary		Modified
198888	Summary of Benefits and Coverage	Other-SBC template-April 2017	Modified

ICR Details

OMB Control No: 1210-0147	ICR Reference No: 201602-1210-002
Status: Historical Active	Previous ICR Reference No: 201502-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Summary of Benefits and Coverage and Uniform Glossary Required Under the Affordable Care Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/06/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/26/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved	04/30/2018
Responses	71,252,326	0	62,909,329
Time Burden (Hours)	431,552	0	387,040
Cost Burden (Dollars)	9,273,266	0	8,188,015

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Abstract: Section 2715 of the PHS Act directs the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (collectively, the Departments), in consultation with the National Association of Insurance Commissioners (NAIC) and a working group comprised of stakeholders, to "develop standards for use by a group health plan and a health insurance issuer in compiling and providing to applicants, enrollees, and policyholders and certificate holders a summary of benefits and coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage. To implement these disclosure requirements, collection of information requests relate to the provision of the following: • Summary of benefits and coverage, which includes coverage examples. • A uniform glossary of health coverage and medical terms. • Notice of modifications.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2715 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2715 Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 78578	12/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9887	02/26/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Glossary
Modifications
Summary of Benefits and Coverage

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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	71,252,326	62,909,329	0	0	8,342,997	0
Annual Time Burden (Hours)	431,552	387,040	0	0	44,512	0
Annual Cost Burden (Dollars)	9,273,266	8,188,015	0	0	1,085,251	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: Estimates have been adjusted to account for new estimates of the number of issuers, plans, participants and beneficiaries affected by the information collection. Also labor rates have been adjusted.

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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: 02/26/2016

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