Group Health Plans Internal Claims and Appeals and External Review Processes

Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0144 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Group Health Plans Internal Claims and Appeals and External Review Processes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2560.503-1 29 CFR 2590.715-2719

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,262,121	Number of Respondents for Small Entity: 1,098,045

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 93 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	155,165	-136,153	291,318
Annual IC Time Burden (Hours)	349	-372	721
Annual IC Cost Burden (Dollars)	750,537	-559,023	1,309,560

Documents for IC

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.