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1210-0123 Cobra 12-14-2022
1210-0123 COBRA 12-14-2022.docx
Notice Requirements of the Health Care Continuation Coverage Provisions
OMB: 1210-0123
OMB.report
DOL/EBSA
OMB 1210-0123
ICR 202210-1210-001
1210-0123 Cobra 12-14-2022
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0123 can be found here:
2026-01-12 - Extension without change of a currently approved collection
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