Mental Health and Substance Abuse Disorder Parity Disclosure Request, Model Notice

Mental Health Parity and Addiction Equity Act of 2008 Notices

OMB: 1210-0138

IC ID: 227109

Information Collection (IC) Details

View Information Collection (IC)

Mental Health and Substance Abuse Disorder Parity Disclosure Request, Model Notice
 
No New
 
Voluntary
 
29 CFR 2590.712(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Model Notice Model disclosure template - FINAL.docx Yes No Printable Only

Health Health Care Services

 

249,008 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 249,008 0 249,008 0 0 0
Annual IC Time Burden (Hours) 20,751 0 20,751 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Model Disclosure Template - Track Changes Version Model Disclosure template compare ROCISed and Final redline 9-3-2019 (002).docx 09/03/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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