OMB control number

Coverage of Certain Preventive Services Under the Affordable Care Act-For-Profit Entities

OMB 1210-0152 · DOL/EBSA.

OMB 1210-0152

Latest Forms, Documents, and Supporting Material

Document Name
Form EBSA Form 700 Self-Certification or Notification Form
1210-0152final(2015-07-14).docx Supporting Statement A
Self-Certification or Notification Form

All Historical Document Collections

201506-1210-001 Approved without change	New collection (Request for a new OMB Control Number)	2015-07-14
201408-1210-003 Comment filed on proposed rule	New collection (Request for a new OMB Control Number)	2014-08-27