Notice of Revocation of Accommodation

Coverage of Certain Preventive Services under the Affordable Care Act—Private Sector

OMB: 1210-0150

IC ID: 258164

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Notice of Revocation of Accommodation
 
No New
 
Required to Obtain or Retain Benefits
 
29 CFR 2590.715-2713A 29 CFR 2510.3-16

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

Health Health Care Services

 

1 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1 0 1 0 0 0
Annual IC Time Burden (Hours) 0 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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