OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

COBRA Notices

IC 246194 under ICR 202103-1210-002 · OMB 1210-0167.

Documents and Forms
Document Name
Document Type
Other-Alternative COBRA subsidy noti
Other-ARP General Notice
Other-Expiration of the Period of Pr
Other-Extended Election Period Notic
Other-FAQs
Other-Summary of ARP requirements
Information Collection (IC) Details

View Information Collection (IC)

COBRA Notices
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Alternative COBRA subsidy notice Alternative COBRA subsidy notice final clean.docx https://www.dol.gov/cobra-subsidy Yes No Fillable Printable
Other-ARP General Notice ARP GENERAL NOTICE - final clean 4.6.21.docx https://www.dol.gov/cobra-subsidy Yes No Fillable Printable
Other-Expiration of the Period of Premium Assistance Notice Expiration of the Period of Premium Assistance Notice -final clean.docx https://www.dol.gov/cobra-subsidy Yes No Fillable Printable
Other-Extended Election Period Notice Extended Election Period Notice final clean.docx https://www.dol.gov/cobra-subsidy Yes No Fillable Printable
Other-FAQs DOL EBSA COBRA subsidy FAQs final clean.docx https://www.dol.gov/cobra-subsidy Yes No Printable Only
Other-Summary of ARP requirements Summary of arp requirements final clean.docx https://www.dol.gov/cobra-subsidy Yes No Printable Only

Income Security General Retirement and Disability

 

726,015 580,660
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 41,455,446 41,455,446 0 0 0 0
Annual IC Time Burden (Hours) 548,983 548,983 0 0 0 0
Annual IC Cost Burden (Dollars) 30,599,590 30,599,590 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.