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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Information Collection (IC) Details

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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:

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 %

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