General Notice of Pre-Existing Condition Exclusion Under Group Health Plans

Notice of Pre-Existing Condition Exclusion Under Group Health Plans

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0102 can be found here:

Documents and Forms

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no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	General Notice of Pre-Existing Condition Exclusion Under Group Health Plans	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.701-3 29 CFR 2520.104b-1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 747,914	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,570,485	-129,515	2,700,000
Annual IC Time Burden (Hours)	1,928	-361	2,289
Annual IC Cost Burden (Dollars)	356,868	84,868	272,000

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.