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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

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: 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 %

table that charts list of burden
	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

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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