Notice for Health Reimbursement Arrangements Integrated with Individual Health Insurance Coverage

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
1210-0160 SSA 1210-0160 HRA 05-06-2022 FINAL.docx	Supporting Statement A	Uploaded 2022-05-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
253233	Participant Notification of Individual Coverage HRA of Cancelled or Discontinued Coverage		New
233410	HRA Notice to Participants and other disclosures	Other-Model	Modified

ICR Details

OMB Control No: 1210-0160	ICR Reference No: 202204-1210-003
Status: Received in OIRA	Previous ICR Reference No: 201905-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice for Health Reimbursement Arrangements Integrated with Individual Health Insurance Coverage
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/13/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2022
Responses	2,140,197	9,399,428
Time Burden (Hours)	53,131	196,992
Cost Burden (Dollars)	24,831	120,662

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Abstract: The rules removed the prohibition on integrating HRAs with individual health insurance coverage, if certain conditions are met including notice requirements. The rules also set forth conditions under which certain HRAs would be recognized as limited excepted benefits. DOL is providing a safe harbor to provide HRA plan sponsors with assurance that the individual health insurance coverage that is integrated with an HRA would not become part of an ERISA plan if the conditions of the safe harbor are met.

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Authorizing Statute(s): US Code: 29 USC 2510 and 2590 Name of Law: Employee Retirement Income Security Act of 1974 (ERISA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 70866	12/13/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 29391	05/13/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
HRA Notice to Participants and other disclosures
Participant Notification of Individual Coverage HRA of Cancelled or Discontinued Coverage

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,140,197	9,399,428	0	0	-7,259,231	0
Annual Time Burden (Hours)	53,131	196,992	0	0	-143,861	0
Annual Cost Burden (Dollars)	24,831	120,662	0	0	-95,831	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: On January 28, 2021, Executive Order 13813 was revoked by Executive Order 14009 , “Strengthening Medicaid and the Affordable Care Act,” however; the regulations are still in effect. The Department also added the burden associated with the requirement in the regulation - Participant Notification of Individual Coverage HRA of Cancelled or Discontinued Coverage. The regulation requires that individual coverage HRA must require that the individual notify the HRA that coverage has been cancelled or discontinued and the date on which the coverage cancellation or discontinuance is effective. It is estimated that an average of 23,167 participants annually will cancel or discontinue their HRA coverage. The burden for this ICR is shared with Treasury/IRS. As a result the Department estimates that there will be 11,584 respondents with a corresponding 965 hours of time burden. The Department has also updated the postage cost, the electronic disclosure rate, and the data inputs.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/13/2022

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