Information Collection

Affordable Care Act Rescission Notice

IC 193289 under ICR 202203-1210-003 · OMB 1210-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0141 can be found here:

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Information Collection (IC) Details

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IC Title:	Affordable Care Act Rescission Notice	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.715-2712

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: 100	Number of Respondents for Small Entity: 100

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

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,744	240	1,504
Annual IC Time Burden (Hours)	19	1	18
Annual IC Cost Burden (Dollars)	230	34	196

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