National Medical Support Notice

Forms and Documents

Document Name	Status
Form 1 National Medical Support Notice Form and Instruction	Modified
NMSN Part A - Supporting Statement 10-4-12.docx Supporting Statement A	2013-06-21

IC Document Collections

IC ID	Document Title	Status
10060	National Medical Support Notice Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0222	ICR Reference No: 201306-0970-005
Status: Historical Active	Previous ICR Reference No: 201012-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: 19857
Title: National Medical Support Notice
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/27/2013
	Date Received in OIRA: 06/25/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	03/31/2016	03/31/2014
Responses	5,279,850	0	726,516
Time Burden (Hours)	897,575	0	123,508
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 401 of the Child Support Performance and Incentives Act of 1998 (CSPIA) Pub.L. 105-200 requires State Child Support Enforcement agencies under title IV-D of the Social Security Act (the Act) to enforce the health care coverage provision in a child support order, and to use the National Medical Support Notice (NMSN) as a means of enforcement. The law requires the NMSN to be promulgated by regulations issued jointly by the Departments of Health and Human Service (HHS) and Labor (DOL). The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) requires all child support orders under title IV-D of the Act to have a provision for medical support coverage. CSPIA requires enforcement of this provision and to use the NMSN as a means of enforcement. State and local Child Support Enforcement agencies send the NMSN to known employers where employees/obligors are employed for the purpose of enrollment of the child into the employee/obligor's health plan. The employer retains the severable wage-withholding portion of the form and withholds from the employee/obligor's wages any premium payments that may be required by the plan. The employer sends the remaining portion of the NMSN to the health plan administrator for enrollment of the child.

---

Authorizing Statute(s): PL: Pub.L. 105 - 200 401(c) Name of Law: Child Support Performance and Incentive Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 39244	07/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 36785	06/19/2013
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
National Medical Support Notice	1	NMSN Part A

---

ICR Summary of Burden

	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	5,279,850	726,516	0	0	4,553,334	0
Annual Time Burden (Hours)	897,575	123,508	0	0	774,067	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The expectation is for an increase in the estimated annual responses of National Medical Support Notices.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/25/2013

---