Notice to Employees of Coverage Options Under Fair Labor Standards Act Section 18B

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
1210-0149 SS 2020.docx	Supporting Statement A	Uploaded 2020-02-10	Available
DOL TR 2013-02.pdf	Supplementary Document	Uploaded 2013-11-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225307	Notice to Employees of Coverage Options Under FLSA Section 18B (State and Local Gov't)	Other-Model Notice	Modified
206431	Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)	Other-Model Notice	Modified

ICR Details

OMB Control No: 1210-0149	ICR Reference No: 202002-1210-005
Status: Active	Previous ICR Reference No: 201701-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice to Employees of Coverage Options Under Fair Labor Standards Act Section 18B
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: 06/25/2020
	Date Received in OIRA: 05/22/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	36 Months From Approved	06/30/2020
Responses	32,068,268	0	29,165,840
Time Burden (Hours)	116,421	0	117,149
Cost Burden (Dollars)	5,238,964	0	4,709,408

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Abstract: Section 18B of the FLSA, as added by section 1512 of the Affordable Care Act, generally provides that, in accordance with regulations promulgated by the Secretary of Labor, an applicable employer must provide each employee at the time of hiring (or with respect to current employees, not later than March 1, 2013), a written notice: 1. Informing the employee of the existence of Exchanges including a description of the services provided by the Exchanges, and the manner in which the employee may contact Exchanges to request assistance; 2. If the employer plan's share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit under section 36B of the Internal Revenue Code (the Code) if the employee purchases a qualified health plan through an Exchange; and 3. If the employee purchases a qualified health plan through an Exchange, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes. The model notice is being to provided by the Department to facilitate compliance with FLSA section 18B.

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Authorizing Statute(s): US Code: 29 USC 218a Name of Law: Fair Labor Standards Act (FLSA)
  

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 31227	05/22/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)
Notice to Employees of Coverage Options Under FLSA Section 18B (State and Local Gov't)

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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	32,068,268	29,165,840	0	0	2,902,428	0
Annual Time Burden (Hours)	116,421	117,149	0	0	-728	0
Annual Cost Burden (Dollars)	5,238,964	4,709,408	0	0	529,556	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: There are no program changes for this submission. The PRA hour and cost burden estimates decreased in this submission because the previous submission reflected one-time start-up costs, which are no longer applicable.

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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]? Yes

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? No

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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: 05/22/2020

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