OMB control number

Notice Requirements of the Health Care Continuation Coverage Provisions

OMB 1210-0123 · DOL/EBSA.

OMB 1210-0123

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides that under certain circumstances participants and beneficiaries of group health plans that satisfy the definition of “qualified beneficiaries” under COBRA may elect to continue group health coverage temporarily following events known as “qualifying events” that would otherwise result in loss of coverage. COBRA provides that the Secretary of Labor (the Secretary) has the authority under section 608 of the Employee Retirement Income Security Act of 1974 (ERISA) to carry out the provisions of Part 6 of title I of ERISA. The Conference Report that accompanied COBRA authorized the Secretary to issue regulations implementing the notice and disclosure requirements of COBRA. Under the regulatory guidelines, plan administrators are required to distribute notices as follows: a general notice to be distributed to all participants in group health plans subject to COBRA; an employer notice that must be completed by the employer upon the occurrence of a qualifying event; a notice and election form to be sent to a participant upon the occurrence of a qualifying event that might cause the participant to lose group health coverage; an employee notice that may be completed by a qualified beneficiary upon the occurrence of certain qualifying events such as divorce or disability; and, two other notices, one of early termination and the other a notice of unavailability. Also included in the ICR are two model notices that the Department believes will help reduce costs for service providers in preparing and delivering notices to comply with the regulations.

The latest form for Notice Requirements of the Health Care Continuation Coverage Provisions expires 2026-07-31 and is listed under ICR 202210-1210-001.

Latest Forms, Documents, and Supporting Material

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202508-1210-007 Extension without change of a currently approved collection 2026-01-12
202210-1210-001 Extension without change of a currently approved collection 2022-12-20 Approved with change
202004-1210-004 No material or nonsubstantive change to a currently approved collection 2020-04-29 Approved without change
201909-1210-006 Extension without change of a currently approved collection 2019-12-20 Approved with change
201609-1210-001 Extension without change of a currently approved collection 2016-10-07 Approved without change
201406-1210-001 No material or nonsubstantive change to a currently approved collection 2014-06-19 Approved without change
201404-1210-002 No material or nonsubstantive change to a currently approved collection 2014-05-02 Approved without change
201307-1210-001 Extension without change of a currently approved collection 2013-09-25 Approved without change
201304-1210-012 No material or nonsubstantive change to a currently approved collection 2013-04-24 Approved without change
201006-1210-002 Revision of a currently approved collection 2010-07-30 Approved without change
201004-1210-004 No material or nonsubstantive change to a currently approved collection 2010-04-21 Approved without change
201002-1210-003 No material or nonsubstantive change to a currently approved collection 2010-03-16 Approved without change
201001-1210-002 No material or nonsubstantive change to a currently approved collection 2010-01-12 Approved without change
200912-1210-002 Revision of a currently approved collection 2009-12-24 Approved without change
200908-1210-002 Extension without change of a currently approved collection 2009-08-24 Approved without change
200902-1210-004 Revision of a currently approved collection 2009-03-05 Approved with change
200704-1210-001 Extension without change of a currently approved collection 2007-07-02 Approved without change
200406-1210-001 New collection (Request for a new OMB Control Number) 2004-06-08 Approved without change