Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans

OMB 1210-0144

This collection of information request includes the information collection and third party notice and disclosure requirements that a plan must satisfy under final regulations implementing provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review process.

The latest form for Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans expires 2022-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
1210-0144 DOL IFR 2 external review ICR 3-25-22 FINAL.docx Supporting Statement A
Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act Other-Model
Group Health Plans Internal Claims and Appeals and External Review Processes

All Historical Document Collections

202202-1210-006 Approved without change	Extension without change of a currently approved collection	2022-03-31
202110-1210-001 Approved without change	Revision of a currently approved collection	2021-10-07
202108-1210-001 Preapproved	Revision of a currently approved collection	2021-10-01
201902-1210-006 Approved without change	Extension without change of a currently approved collection	2019-04-01
201510-1210-008 Approved without change	Revision of a currently approved collection	2015-11-20
201507-1210-001 Approved without change	Extension without change of a currently approved collection	2015-07-23
201203-1210-002 Approved without change	Extension without change of a currently approved collection	2012-05-02
201105-1210-001 Approved with change	Revision of a currently approved collection	2011-06-23
201011-1210-011 Approved without change	Extension without change of a currently approved collection	2011-02-28
201008-1210-003 Approved with change	Revision of a currently approved collection	2010-08-18
201008-1210-002 Approved without change	Revision of a currently approved collection	2010-08-18
201007-1210-007 Preapproved	New collection (Request for a new OMB Control Number)	2010-07-19

OMB Details

Non-Grandfathered Group Health Plans Internal Claims and Appeals and External Review Processes

Federal Enterprise Architecture: Income Security - General Retirement and Disability