Information Collection

Group Health Plans Internal Claims and Appeals and External Review Processes

IC 193842 under ICR 202501-1210-005 · OMB 1210-0144.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0144 can be found here:

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Information Collection (IC) Details

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IC Title:	Group Health Plans Internal Claims and Appeals and External Review Processes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2560.503-1 29 CFR 2590.715-2719

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,007,298	Number of Respondents for Small Entity: 1,746,349

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

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Previously Approved
Annual Number of Responses for this IC	314,560	314,560
Annual IC Time Burden (Hours)	14,432	14,432
Annual IC Cost Burden (Dollars)	571,599	571,599

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