Information Collection

Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

IC 191431 under ICR 202305-1210-003 · OMB 1210-0138.

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IC Title:

Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.712(d)(2)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 949,149

Number of Respondents for Small Entity: 825,760

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 58 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	949,149	-102,140	1,051,289
Annual IC Time Burden (Hours)	79,096	-8,511	87,607
Annual IC Cost Burden (Dollars)	341,200	11,621	329,579

Documents for IC

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