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Notice Requirements of the Health Care Continuation Coverage Provisions
ICR 202210-1210-001
OMB: 1210-0123
Federal Form Document
OMB.report
DOL/EBSA
OMB 1210-0123
ICR 202210-1210-001
( )
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1210-0123 can be found here:
2026-01-12 - Extension without change of a currently approved collection
Forms and Documents
Document
Name
Status
1210-0123 COBRA 12-14-2022.docx
Supporting Statement A
2022-12-14
IC Document Collections
IC ID
Document
Title
Status
13504
Notice Requirements of the Health Care Continuation Coverage Provisions
Other-COBRA Model General Notice
Modified
ICR Details
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