Establishing Creditable Coverage under Group Health Plans

ICR 201211-1210-004

OMB: 1210-0103

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2012-12-21
IC Document Collections
IC ID
Document
Title
Status
38420
Modified
ICR Details
1210-0103 201211-1210-004
Historical Active 200911-1210-003
DOL/EBSA
Establishing Creditable Coverage under Group Health Plans
Extension without change of a currently approved collection   No
Regular
Approved without change 01/31/2013
Retrieve Notice of Action (NOA) 12/27/2012
  Inventory as of this Action Requested Previously Approved
01/31/2016 36 Months From Approved 01/31/2013
8,164,356 0 19,593,756
74,000 0 88,066
12,400,000 0 13,830,615

This ICR covers an information collection requirement imposed under the regulations in connection with the alternative method of crediting coverage established by the regulations. The regulations permit a plan to adopt, as its method of crediting prior health coverage, provisions that impose different preexisting condition exclusion periods with respect to different categories of benefits, depending on prior coverage in that category. In such a case, the regulations require former plans to provide additional information upon request to new plans in order to establish an individual's length of prior creditable coverage within that category of benefits.

US Code: 29 USC 1181 Name of Law: Employee Retirement Income Security Act of 1974
  
None

Not associated with rulemaking

  77 FR 37920 06/25/2012
77 FR 76303 12/27/2012
No

1
IC Title Form No. Form Name
Establishing Creditable Coverage under Group Health Plans

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 8,164,356 19,593,756 0 0 -11,429,400 0
Annual Time Burden (Hours) 74,000 88,066 0 0 -14,066 0
Annual Cost Burden (Dollars) 12,400,000 13,830,615 0 0 -1,430,615 0
No
No
There have been no program changes to this ICR since the last submission in 2009. The Department has updated the estimates of respondents (plans) and responses, as well as the assumptions relating to cost (e.g., labor rates and worker characteristics). These changes have resulted in an increase in the numbers of responses, and a corresponding increase in the overall burden of this information collection. Additionally, it appears that the last submission contained a typographical error, whereby the cost of service providers was off by a factor of ten. Correcting this error and updating the inputs in the formula has resulted in an increase in the stated cost of service providers.

$0
No
No
No
No
No
Uncollected
Chris Cosby 202 693-8540

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/27/2012


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