No material or nonsubstantive change to a currently approved collection
No
Regular
Approved without change
03/03/2023
03/03/2023
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
11/30/2025
11/30/2025
11/30/2025
9,746,434
0
9,746,434
1,656,939
0
1,656,939
0
0
0
OMB approved the NMSN Part for an additional three years with an expiration date of November 30, 2025. OMB also approved OCSEâs request to extend the prior NMSN Part A until 10/31/2023 to allow states to program the revisions to Part A.
The Office of Child Support Enforcement developed the 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 form was developed with input from employer groups and health plan administrators, and complies with section 609 (a)(3) and (4) of the Employee Retirement Income Security Act of 1974 (ERISA), which pertains to informational requirements and restrictions against requiring new types of forms for benefits.
The recently approved NMSN Part A and Part A sample have only one line for users to provide information in the âlast known addressâ field. While creating a PDF to properly capture the information, OCSE needed to add additional and separate lines to the last known address field. OCSE requests OMB approve these minor changes to the NMSN Part A and the Part A Sample.
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 nonsub request is to make modifications to the recently approved NMSN Part A and Part A sample. Past versions have only one line for users to provide information in the âlast known addressâ field. While creating a PDF to properly capture the information, OCSE needed to add additional and separate lines to the last known address field pg. 3 on Part A and Part A Sample.
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
US Code:
42 USC 666
Name of Law: Requirement of statutorily prescribed procedures to improve effectiveness of child supp enforcement
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:
(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;
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.
State Medical Support Contacts and Program Requirement Matrix (State Respondents)