TD 9724 - Summary of Benefits and Coverage Disclosures

Forms and Documents

Document	Type	Status	Availability
1545-2229 Justification for Change 2017-03.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-03-22	Available
Simple fracture.pdf	Supplementary Document	Uploaded 2016-04-05	Available
SBC Sample Completed 4 4 clean.doc	Supplementary Document	Uploaded 2016-04-05	Repair queued
SBC Template 4 4 clean.doc	Supplementary Document	Uploaded 2016-04-05	Repair queued
UG 4-1-16 -12 pm clean.doc	Supplementary Document	Uploaded 2016-04-05	Available
Yes Answers 4 1 12 pm clean.doc	Supplementary Document	Uploaded 2016-04-05	Available
No Answers 4 1 12 pm clean.doc	Supplementary Document	Uploaded 2016-04-05	Repair queued
maternity-narrative.pdf	Supplementary Document	Uploaded 2016-04-05	Available
Copy of Copy of coverage_examples_calculator 02 07.xlsm	Supplementary Document	Uploaded 2016-04-05	Repair queued
coverage_examples_calculator instructions FINAL.docx	Supplementary Document	Uploaded 2016-04-05	Available
Copy of Managing Type 2 Diabetes.xlsx	Supplementary Document	Uploaded 2016-04-05	Available
Copy of Simple fracture.xlsx	Supplementary Document	Uploaded 2016-04-05	Available
Copy of Having a baby.xlsx	Supplementary Document	Uploaded 2016-04-05	Available
SBC Template 4 4 clean.doc	Supplementary Document	Uploaded 2016-04-05	Available
SBC Response to Comments 4 5 16 clean.docx	Supplementary Document	Uploaded 2016-04-05	Available
No Answers 4 1 12 pm clean.doc	Supplementary Document	Uploaded 2016-04-05	Repair queued
Individual Instructions 4 4 clean.docx	Supplementary Document	Uploaded 2016-04-05	Available
Group Instructions 4 4 clean.docx	Supplementary Document	Uploaded 2016-04-05	Available
IRS PRA supporting statement4 4 16(nn) (2)(NEW).doc	Supporting Statement A	Uploaded 2017-03-22	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
199118	TD 9724 - Summary of Benefits and Coverage Disclosures		Modified

ICR Details

OMB Control No: 1545-2229	ICR Reference No: 201703-1545-005
Status: Historical Active	Previous ICR Reference No: 201604-1545-003
Agency/Subagency: TREAS/IRS	Agency Tracking No: Not Ready
Title: TD 9724 - Summary of Benefits and Coverage Disclosures
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/22/2017
	Date Received in OIRA: 03/22/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	04/30/2019	04/30/2019
Responses	71,252,326	0	213,624,047,553
Time Burden (Hours)	431,553	0	431,550
Cost Burden (Dollars)	9,273,266	0	1,749,999,652,592

---

Abstract: This document contains regulations regarding disclosure of the summary of benefits and coverage and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the Patient Protection and Affordable Care Act. This document implements the disclosure requirements to help plans and individuals better understand their health coverage, as well as other coverage options. The templates and instructions to be used in making these disclosures are being issued in a separate notice.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 2701- 2719A Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 78578	12/31/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9945	02/26/2016
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
TD 9724 - Summary of Benefits and Coverage Disclosures

---

ICR Summary 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	213,624,047,553	0	-213,552,795,227	0	0
Annual Time Burden (Hours)	431,553	431,550	0	3	0	0
Annual Cost Burden (Dollars)	9,273,266	1,749,999,652,592	0	-1,749,990,379,326	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Non labor costs and number of respondents were incorrectly reflected in our previous submission. The correct non labor costs are $9,273,266 and number of respondents is 71,252,236. The total burden hours remain relatively unchanged at 431, 553. The IRS has updated the supporting statement to include a Table 2. Summary of Burden to reflect the changes made to this submission.

---

Annual Cost to Federal Government:

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]? Yes

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 03/22/2017

---