Notice of Pre-Existing Condition Exclusion

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
13442	Notice of Pre-Existing Condition Exclusion	Migrated

ICR Details

OMB Control No: 1210-0102	ICR Reference No: 199704-1210-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice of Pre-Existing Condition Exclusion
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/01/1997
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/30/1997
	Date Received in OIRA: 04/08/1997
Terms of Clearance: These information collection requirements are granted an emergency 6-month approval pursuant to the Paperwork Reduction Act under the following conditions: 1) in the preamble the final rule and in the next PRA submission, HHS, DoL, and Treasury respond in writing and in more detail to the concerns expressed in public comment received by OMB and forwarded to the agencies on these information requirements; 2) in the context of the final rule and as part of the next PRA submission, the Departments continue to evaluate the burden imposed by these requirements upon the health insurance industry and employers, in particular the burden of providing certificates of dependency coverage. The final rulemaking and next PRA submission must reflect the Departments' analysis, based on all available feedback from plans and employers, of the actual comprehensive burden imposed and other relevant implementation factors.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1998	03/31/1998
Responses	90,470	0	0
Time Burden (Hours)	1,235	0	0
Cost Burden (Dollars)	75,000	0	0

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Abstract: Pursuant to 29 CFR 2590.701-3(c), a group health plan offering group health insurance coverage may not impose any pre-existing condition exclusions on a participant unless the participant has been notified of the plan's provisions and his or her right to establish prior creditable coverage. 29 CFR 2590.701-4 requires that plans that use the alternative method of crediting coverage disclose their method at the time of a participant's enrollment in the plan. 29 CFR 2590.701-5(d) requires that before a plan imposes a pre-existing condition exclusion on a particular participant, it must first disclose that....

Emergency Justfication:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Notice of Pre-Existing Condition Exclusion

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	90,470	0	0	90,470	0	0
Annual Time Burden (Hours)	1,235	0	0	1,235	0	0
Annual Cost Burden (Dollars)	75,000	0	0	75,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/08/1997

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