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

Forms and Documents

Document Name	Status
1210-0053 Claims Procedure ss20.docx Supporting Statement A	2020-01-23

IC Document Collections

IC ID	Document Title	Status
13352	Employee Benefit Plan Claims Procedure Under ERISA	Modified

ICR Details

OMB Control No: 1210-0053	ICR Reference No: 202001-1210-001
Status: Active	Previous ICR Reference No: 201611-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/06/2020
	Date Received in OIRA: 02/26/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	04/30/2020
Responses	1,465,526,748	0	311,790,227
Time Burden (Hours)	1,627,422	0	516,227
Cost Burden (Dollars)	1,959,351,534	0	814,449,932

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 54642	10/10/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 11104	02/26/2020
Did the Agency receive public comments on this ICR? No

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

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

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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	1,465,526,748	311,790,227	0	0	1,153,736,521	0
Annual Time Burden (Hours)	1,627,422	516,227	0	0	1,111,195	0
Annual Cost Burden (Dollars)	1,959,351,534	814,449,932	0	0	1,144,901,602	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: The increased burden is due to a correction in the estimate of the burden to include post-service approved claims in the burden estimate of the number of notices. A review of FAQs issued by the agency highlighted that approved claims still could be an adverse determination if 100 percent of the claim was not paid (even if in-line with plan requirements due to co-pays, deductibles, and other cost-sharing arrangements). The adverse determination would require notice, which often occurs in the form of an explanation of benefits (EOBs).

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 02/26/2020

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