Information Collection

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

IC 191431 under ICR 202405-1210-001 · 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:

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: 1,064,758	Number of Respondents for Small Entity: 990,225

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

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,064,758	13,469	1,051,289
Annual IC Time Burden (Hours)	88,730	1,123	87,607
Annual IC Cost Burden (Dollars)	412,924	83,345	329,579

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.