COBRA Notification Requirements--American Recovery and Reinvestment Act of 2009 as amended by Department of Defense Appropriations Act, 2010

Notice Requirements of the Health Care Continuation Coverage Provisions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0123 can be found here:

Documents and Forms

Document Name Document Type
Updated Model General Notice - full version 12 23 09 final.doc Other-Updated Model General Notice
Updated Model Alternative Notice 12 23 09 final.doc Other-Updated Model Alternative Noti
Model Premium Assistance Extension Notice 12 23 09 final.doc Other-Model Premium Extension Notice
ARRA extension model FR notice 12 23 09 final.doc ARRA Extension Draft Federal Register Notice IC Document
COBRAEmergencyFRN2010.doc ARRA Emergency Federal Register Notice IC Document

Information Collection (IC) Details

IC Title:	COBRA Notification Requirements--American Recovery and Reinvestment Act of 2009 as amended by Department of Defense Appropriations Act, 2010	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 2590.606(a)

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Updated Model General Notice	Updated Model General Notice - full version 12 23 09 final.doc	Yes	No	Printable Only
Other-Updated Model Alternative Notice	Updated Model Alternative Notice 12 23 09 final.doc	Yes	No	Printable Only
Other-Model Premium Extension Notice	Model Premium Assistance Extension Notice 12 23 09 final.doc	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,700,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,500,000	-14,377,000	22,877,000
Annual IC Time Burden (Hours)	0	0	0
Annual IC Cost Burden (Dollars)	6,800,000	-9,312,734	16,112,734

Documents for IC

Title	Document	Date Uploaded
ARRA Extension Draft Federal Register Notice	ARRA extension model FR notice 12 23 09 final.doc	12/24/2009
ARRA Emergency Federal Register Notice	COBRAEmergencyFRN2010.doc	12/24/2009

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