Information Collection

Patient Protection and Affordable Care Act Patient Protection Notice

IC 193285 under ICR 202202-1210-003 · OMB 1210-0142.

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IC Title:

Patient Protection and Affordable Care Act Patient Protection Notice

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.722

Information Collection Instruments:

table that charts list of 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: 11,241

Number of Respondents for Small Entity: 10,791

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 58 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	148,181	20,048	128,133
Annual IC Time Burden (Hours)	2,810	-724	3,534
Annual IC Cost Burden (Dollars)	7,409	5,807	1,602

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table that charts IC Documents
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.