Notice Requirements of the Health Care Continuation Coverage Provisions

OMB 1210-0123

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 2023-01-31 and can be found here.

All Historical Document Collections
Approved with change
Extension without change of a currently approved collection 2022-12-20
Approved without change
No material or nonsubstantive change to a currently approved collection 2020-04-29
Approved with change
Extension without change of a currently approved collection 2019-12-20
Approved without change
Extension without change of a currently approved collection 2016-10-07
Approved without change
No material or nonsubstantive change to a currently approved collection 2014-06-19
Approved without change
No material or nonsubstantive change to a currently approved collection 2014-05-02
Approved without change
Extension without change of a currently approved collection 2013-09-25
Approved without change
No material or nonsubstantive change to a currently approved collection 2013-04-24
Approved without change
Revision of a currently approved collection 2010-07-30
Approved without change
No material or nonsubstantive change to a currently approved collection 2010-04-21
Approved without change
No material or nonsubstantive change to a currently approved collection 2010-03-16
Approved without change
No material or nonsubstantive change to a currently approved collection 2010-01-12
Approved without change
Revision of a currently approved collection 2009-12-24
Approved without change
Extension without change of a currently approved collection 2009-08-24
Approved with change
Revision of a currently approved collection 2009-03-05
Approved without change
Extension without change of a currently approved collection 2007-07-02
Approved without change
New collection (Request for a new OMB Control Number) 2004-06-08

© 2024 OMB.report | Privacy Policy