National Medical Support Notice - Part A

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents)	Form	New	Repair queued
Form Part A - Revised 2 National Medical Support Notice-Part A (Employer Respondents)	Form	Modified	Repair queued
Form Part A - Revised 2 National Medical Support Notice-Part A (State Respondents)	Form	Modified	Available
Attachment A - Public Comments Received on the National Medical Support Notice Part A_final.docx	Supplementary Document	Uploaded 2022-09-16	Repair queued
2022 07 22 NMSN_Part_A_Sample_Form_FINAL clean.docx	Supplementary Document	Uploaded 2022-09-16	Missing upstream
NMSN Part A Supporting Statement _9.15.22_final.docx	Supporting Statement A	Uploaded 2022-09-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
255976	State Medical Support Contacts and Program Requirement Matrix (State Respondents)	Form	New
236881	National Medical Support Notice-Part A (Employer Respondents)	Form	Modified
10060	National Medical Support Notice-Part A (State Respondents)	Form	Modified

ICR Details

OMB Control No: 0970-0222	ICR Reference No: 202209-0970-007
Status: Received in OIRA	Previous ICR Reference No: 201911-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: OCSE
Title: National Medical Support Notice - Part A
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/22/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2022
Responses	9,746,434	9,674,851
Time Burden (Hours)	1,656,939	1,644,725
Cost Burden (Dollars)	0	0

---

Abstract: The Office of Child Support Enforcement (OCSE) developed the National Medical Support Notice (NMSN) Part A as a standard, required form for child support enforcement agencies to use to ensure dependent children are enrolled in available employer-sponsored medical coverage, if required by a support order. The information collected complies with section 401 of the Child Support Performance and Incentives Act of 1998 (CSPIA), which requires state child support agencies, under title IV-D of the Social Security Act, (the Act), to enforce health care coverage provided in a child support order and section 609 of the Employee Retirement Income Security Act of 1974 (ERISA), which deems the NMSN the enforcement mechanism for the medical support requirement. The laws require the NMSN to be promulgated by regulations issued jointly by the Departments of Health and Human Services (HHS) and Labor (DOL). The collection activities associated with the NMSN are further authorized by (1) 42 U.S.C. § 666, which requires all child support orders to include a provision for medical support and where appropriate, enforced through the use of the National Medical Support Notice; (2) 29 U.S.C. § 1169, which provides for medical coverage pursuant to a qualified medical support order. This request includes revisions to the currently approved NMSN Part A - see A.15 for an explanation of changes. We are also requesting to extend approval of the currently approved NMSN Part A for one additional year to allow states to program their systems to accommodate the proposed changes to Part A and instructions. Once the system is programmed, states will then be required to use the revised version of the NMSN Part A.

---

Authorizing Statute(s): US Code: 42 USC 666 Name of Law: Requirement of statutorily prescribed procedures to improve effectiveness of child supp enforcement
   US Code: 29 USC 1169 Name of Law: Additional standards for group health plans
   US Code: 45 USC 303.32 Name of Law: National Medical Support Notice
   PL: Pub.L. 105 - 200 401(c) Section 609 Name of Law: Child Support Performance and Incentive Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 26762	05/05/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 57701	09/21/2022
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
National Medical Support Notice-Part A (Employer Respondents)	Part A - Revised 2022, Part A - 2019 Version	National Medical Support Notice – Part A ,   National Medical Support Notice – Part A
National Medical Support Notice-Part A (State Respondents)	Part A - Revised 2022, Part A - 2019 Version	National Medical Support Notice - Part A ,   National Medical Support Notice Part A (2019)
State Medical Support Contacts and Program Requirement Matrix (State Respondents)	NMSN Matrix	State Medical Support Contacts and Program Requirement Matrix

---

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	9,746,434	9,674,851	0	71,583	0	0
Annual Time Burden (Hours)	1,656,939	1,644,725	0	12,214	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: OCSE made minor revisions to the NMSN Part A to simplify the form. OCSE also split the form instructions into a separate document, created a Sample NMSN Part A, and added questions to the “State Medical Support Contacts and Program Requirements” Matrix. The Matrix questions will ensure employers have clear and specific information necessary to comply with individual state's requirements. The revisions and new documents constitute a program change. As a result of the 7 comments received during the 60-day comment period, OCSE updated the NMSN Part A, the accompanying instructions, and the Sample NMSN Part A. See no. 8, above and Attachment A for additional information. Finally, since the previous approval, OCSE adjusted the state burden estimate from 89,634 to 90,194, to account for an increase in the number of NMSN forms submitted by state IV-D agencies and also reflects an estimate for each state to annually update the State Medical Support Contacts and Program Requirement Matrix; OCSE adjusted the employer burden estimate based on the number of employers submitting NMSN forms from 1,275,624 (in 2016) to 1,310,727 (in 2018) reflecting the most recent census data available.

---

Annual Cost to Federal Government: $183,727

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.     Yes

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]? No

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

---

Common Form ICR:  No

---

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: 09/22/2022

---