OMB
.report
Search
Affordable Care Act Patient Protection Notice
Affordable Care Act Patient Protection Notice
OMB: 1210-0142
IC ID: 193285
OMB.report
DOL/EBSA
OMB 1210-0142
ICR 201006-1210-003
IC 193285
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0142 can be found here:
2022-03-15 - Extension without change of a currently approved collection
2021-08-24 - Revision 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:
Affordable Care Act Patient Protection Notice
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 2590.715-2719A
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:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
261,680
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
6,186,404
6,186,404
0
0
0
0
Annual IC Time Burden (Hours)
33,000
33,000
0
0
0
0
Annual IC Cost Burden (Dollars)
48,000
48,000
0
0
0
0
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.