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General Notice of Pre-Existing Condition Exclusion Under Group Health Plans
Notice of Pre-Existing Condition Exclusion Under Group Health Plans
OMB: 1210-0102
IC ID: 38419
OMB.report
DOL/EBSA
OMB 1210-0102
ICR 200911-1210-002
IC 38419
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0102 can be found here:
2012-12-26 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
827,330
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
38 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3,254,283
0
0
683,798
0
2,570,485
Annual IC Time Burden (Hours)
2,373
0
0
445
0
1,928
Annual IC Cost Burden (Dollars)
453,901
0
0
97,033
0
356,868
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.