Information Collection

Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

IC 191315 under ICR 201602-1545-027 · OMB 1545-2165.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2165 can be found here:

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Information Collection (IC) Details

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IC Title:	Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9812-1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,284,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	114,000	0	-109,200	223,200
Annual IC Time Burden (Hours)	5,988	4,088	0	1,900
Annual IC Cost Burden (Dollars)	256,000	256,000	0	0

Documents for IC

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.