Information Collection Request
Notice Requirements of the Health Care Continuation Coverage Provisions
ICR 202210-1210-001 · OMB 1210-0123 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1210-0123 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 1210-0123 COBRA 12-14-2022.docx |
Supporting Statement A | Uploaded 2022-12-14 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 13504 |  Notice Requirements of the Health Care Continuation Coverage Provisions |
Other-COBRA Model General Notice | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/EBSA |
| OMB Control No | 1210-0123 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202004-1210-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |