Information Collection

Registration of Group Health Plans and Health Insurance Issuers

IC 280783 under ICR 202606-1210-003 · OMB 1210-0169.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Health Plan Registry Instrument clean 6.8.26.docx	Other-Health Plan Registry Instrumen

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590

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
Other-Health Plan Registry Instrument					Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 396

Number of Respondents for Small Entity: 348

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	396	396
Annual IC Time Burden (Hours)	1,816	1,816
Annual IC Cost Burden (Dollars)	0	0

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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