OMB control number

National Medical Support Notice - Part A

OMB 0970-0222 · HHS/ACF.

OMB 0970-0222

The Office of Child Support Enforcement (OCSE) developed the National Medical Support Notice (NMSN) - Part A in accordance with the Child Support Performance and Incentives Act of 1998 and the Employee Retirement Income Security Act of 1974. The laws required OCSE to promulgate NMSN regulations, which were issued jointly by the Departments of Health and Human Services and Labor. The information collection activities associated with the NMSN are authorized by (1) 42 U.S.C. § 666, which requires all child support orders to include a provision for medical support, and where appropriate, enforced through the National Medical Support Notice; and (2) 29 U.S.C. § 1169, which provides for medical coverage pursuant to a qualified medical support order. The NMSN Part A is a standard, required form that child support agencies (CSAs) use to ensure employers enroll dependent children in available employer-sponsored medical coverage, if required by a child support order. The Department of Labor develops and maintains the required Part B form (OMB #: 1210-0113) that employers use to inform a plan administrator that a participant is obligated by an order to provide health care coverage for dependent children. As part of the most recent revision request, ACF requested an implementation period and estimated burden for a one year implementation period. In reviewing the request in ROCIS, ACF has realized that burden was double counted by the way it was entered into the system. This request fixes that error.

The latest form for National Medical Support Notice - Part A expires 2028-12-31 and is listed under ICR 202605-0970-009.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form NMSN Matrix State Medical Support Contacts and Program Requirement MatrixForm
Form NMSN Matrix State Medical Support Contacts and Program Requirement MatrixForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
Form 1 National Medical Support Notice Part AForm
NonSub Change Request _NMSN Burden Adjustment ROCIS.docxJustification for No Material/Nonsubstantive Change
NonSub Change Request _NMSN Burden Adjustment ROCIS.docxJustification for No Material/Nonsubstantive Change
NMSN Response to Comments - 30 Day FRN.docxSupplementary Document
NMSN Response to Comments - 30 Day FRN.docxSupplementary Document
2025-08-29 NMSN Part A Supporting Statement FINAL_9.12.25 - burden exp update 2026_clean.docxSupporting Statement A
2025-08-29 NMSN Part A Supporting Statement FINAL_9.12.25 - burden exp update 2026_clean.docxSupporting Statement A
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward Instruction
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward Instruction
National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Form
National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Form
National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Instruction
National Medical Support Notice-Part A (State Respondents) - 2026 Forward Form
National Medical Support Notice-Part A (State Respondents) - 2026 Forward Form
National Medical Support Notice-Part A (State Respondents) - 2026 Forward Instruction
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year Instruction
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year Form
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year Instruction
State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form
State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form
National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Form
National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Form
National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Instruction
National Medical Support Notice-Part A (State Respondents) - Implementation Year Form
National Medical Support Notice-Part A (State Respondents) - Implementation Year Form
National Medical Support Notice-Part A (State Respondents) - Implementation Year Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202605-0970-009 No material or nonsubstantive change to a currently approved collection 2026-05-29
202509-0970-004 Revision of a currently approved collection 2025-09-16
202504-0970-026 No material or nonsubstantive change to a currently approved collection 2025-05-28
202401-0970-001 No material or nonsubstantive change to a currently approved collection 2024-01-03 Approved without change
202302-0970-005 No material or nonsubstantive change to a currently approved collection 2023-03-03 Approved without change
202211-0970-008 No material or nonsubstantive change to a currently approved collection 2022-11-23 Approved without change
202209-0970-007 Revision of a currently approved collection 2022-09-22 Approved without change
201911-0970-001 No material or nonsubstantive change to a currently approved collection 2019-11-04 Approved without change
201907-0970-003 Revision of a currently approved collection 2019-07-15 Approved without change
201606-0970-008 Extension without change of a currently approved collection 2016-06-28 Approved with change
201308-0970-003 No material or nonsubstantive change to a currently approved collection 2013-08-29 Approved without change
201306-0970-005 Extension without change of a currently approved collection 2013-06-25 Approved without change
201012-0970-001 Revision of a currently approved collection 2010-12-06 Approved without change
200712-0970-005 Revision of a currently approved collection 2007-12-17 Approved without change
200411-0970-005 Reinstatement with change of a previously approved collection 2004-11-30 Approved without change
200011-0970-001 New collection (Request for a new OMB Control Number) 2000-11-08 Approved without change

OMB Details

National Medical Support Notice-Part A (State Respondents) - Implementation Year

Federal Enterprise Architecture: Community and Social Services - Social Services

Information collection instruments
FormNameElectronic accessType
Form 1National Medical Support Notice Part AFillable FileableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.