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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
OMB: 1210-0123
IC ID: 188172
OMB.report
DOL/EBSA
OMB 1210-0123
ICR 201002-1210-003
IC 188172
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0123 can be found here:
2022-12-20 - Extension without change of a currently approved collection
2020-04-29 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Updated Model Alternative Notice final.doc
Other-Model Notice
Updated Model General Notice - full version final.doc
Other-Model Notice
Model Premium Assistance Extension Notice final.doc
Other-Model 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
View Information Collection (IC)
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:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
29 CFR 2590.606(a)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Model Notice
Updated Model Alternative Notice final.doc
Yes
No
Printable Only
Other-Model Notice
Updated Model General Notice - full version final.doc
Yes
No
Printable Only
Other-Model Notice
Model Premium Assistance Extension Notice final.doc
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
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
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
8,500,000
0
0
0
0
8,500,000
Annual IC Time Burden (Hours)
0
0
0
0
0
0
Annual IC Cost Burden (Dollars)
6,800,000
0
0
0
0
6,800,000
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.