Information Collection

Group Health Plans Internal Claims and Appeals and External Review Processes

IC 193842 under ICR 202503-1210-004 · OMB 1210-0144.

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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: Modified

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: 1,294,150	Number of Respondents for Small Entity: 1,229,443

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

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	152,729	-161,831	314,560
Annual IC Time Burden (Hours)	14,135	-297	14,432
Annual IC Cost Burden (Dollars)	581,489	9,890	571,599

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