Information Collection Request
Model Employer Children's Health Insurance Program Notice
ICR 202211-1210-002 · OMB 1210-0137 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1210-0137 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 1210-0137 CHIPRA Model Notice 12-14-2022 Clean.docx |
Supporting Statement A | Uploaded 2022-12-14 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 208807 |  Model Employer CHIP Notice (State, Local, Tribal Governmental Burden) |
Other-Model Notice | Modified | |
| 191695 | Model Employer CHIP Notice (Private Sector Burden) |
Other-Model Notice | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/EBSA |
| OMB Control No | 1210-0137 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201909-1210-008 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |