NonSub Change Memo - 2023 Changes

To: Kelsi Feltz

Office of Information and Regulatory Affairs (OIRA)

Office of Management and Budget (OMB)

From: Lynnetta Thompson

Federal Manager

Information Collection Request

Office of Child Support Enforcement (OCSE)

Administration for Children and Families (ACF)

Date: March 2, 2023

Subject: Non-Substantive Change Request – National Medical Support Notice Part A and Part A Sample (OMB # 0970-0222)

This memo requests approval of non-substantive changes to the approved information collection, National Medical Support Notice (NMSN) Part A and Part A Sample (OMB # 0970-0222).

Background

OMB approved the NMSN Part A and Part A Sample for an additional three years with an expiration date of November 30, 2025. OMB also approved OCSE’s 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.

Overview of Requested Changes

The recently approved NMSN Part A and Part A sample have only one line for users to provide information in the “last known address” 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.

Other minor changes were found while reviewing these forms:

1. Agency links were added to the form pg.1 and to the instructions pg. 4 Part A and Part A sample

2. Employer liability language for contacts was clarified pg. 5 Part A and Part A sample

3. Second PRA display language removed from instructions pg. 5 Part A and the Part A sample

4. Contact language clarified pg. 6 Part A and the Part A sample

5. OMB number and expiration date were removed from the right top corner of the Part A sample on pg. 1 to correspond with Part A format 

OCSE requests OMB approve these minor changes to the NMSN Part A and the Part A Sample.

Time Sensitivities

An immediate approval is requested (with no change in the approved expiration date). States are required to update the approved NMSN forms by 10/31/2023 before sending the NMSN to employers for their use.