Information Collection Request

Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage

ICR 202312-1545-010 · OMB 1545-2178 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Supporting Statement-1545-2178.docx Supporting Statement A Uploaded 2024-03-21 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
263884 Grandfathered Plan Change in Carrier Disclosure New
193151 Grandfathered Plan Disclosure and Recordkeeping Requirement Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2027 36 Months From Approved 05/31/2024
8,868,468 0 66,600
655 0 2,220
125,533 0 366,800





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Grandfathered Plan Change in Carrier Disclosure
Grandfathered Plan Disclosure and Recordkeeping Requirement

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 8,868,468 66,600 0 0 8,801,868 0
Annual Time Burden (Hours) 655 2,220 0 0 -1,565 0
Annual Cost Burden (Dollars) 125,533 366,800 0 0 -241,267 0


Reginfo record details
  No