Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
1210-0053ss 12-1-2016 final.docx	Supporting Statement A	Uploaded 2016-12-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13352	Employee Benefit Plan Claims Procedure Under ERISA		Modified

ICR Details

OMB Control No: 1210-0053	ICR Reference No: 201611-1210-001
Status: Historical Active	Previous ICR Reference No: 201607-1210-004
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act
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: 02/01/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/19/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	11/30/2019
Responses	311,790,227	0	311,153,000
Time Burden (Hours)	516,227	0	492,500
Cost Burden (Dollars)	814,449,932	0	719,438,000

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Abstract: ERISA Section 503 and regulations at 29 CFR 2560.503-1 require employee benefit plans to establish procedures for resolving benefit claims under the plan, including initial claims and appeal of denied claims. The regulation requires specific information to be disclosed at different stages of the claims process. It also requires claims denial notices to be provided within specific time frames and to include specific information.

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Authorizing Statute(s): US Code: 29 USC 1133 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB39	Final or interim final rulemaking	81 FR 92316	12/19/2016

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 72014	11/18/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Employee Benefit Plan Claims Procedure Under ERISA

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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	311,790,227	311,153,000	0	2,321	634,906	0
Annual Time Burden (Hours)	516,227	492,500	0	0	23,727	0
Annual Cost Burden (Dollars)	814,449,932	719,438,000	0	15,805,959	79,205,973	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: Changes in estimates since the most recent ICR renewal reflect changes to the disability claims part of the regulations (increase of 2,321 burden hours, and $15,805,959), and increases in hour burden and costs burden due to updated estimates including labor rates, the percent of long term disability claims denied, the percent of disability claims sent electronically (decrease form 75 percent to 30 percent), and the number of health and welfare plans.

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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]? No

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: 12/19/2016

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