Information Collection Request
Affordable Care Act Grandfathered Health Plan Disclosure, Recordkeeping Requirement, and Change in Carrier Disclosure
ICR 202412-1210-001 · OMB 1210-0140 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 1210-0140 Grandfathering SS 3-20-25.docx |
Supporting Statement A | Uploaded 2025-03-20 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 195225 |  Grandfathered Plan Change in Carrier Disclosure |
Modified | ||
| 193127 | Grandfathered Plan Disclosure and Recordkeeping Requirement |
Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/EBSA |
| OMB Control No | 1210-0140 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202203-1210-001 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |