Annual Report for Multiple Employer Welfare Arrangements (Form M-1)

Forms and Documents

Document Name	Status
Form Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction	Modified
M-1 Justification of Nomaterial Change(20130906).doc Justification for No Material/Nonsubstantive Change	2013-09-06
1210-0116-SSPRA-11-14-2012.docx Supporting Statement A	2012-11-14

IC Document Collections

IC ID	Document Title	Status
13484	Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction	Modified

ICR Details

OMB Control No: 1210-0116	ICR Reference No: 201308-1210-003
Status: Historical Active	Previous ICR Reference No: 201303-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Annual Report for Multiple Employer Welfare Arrangements (Form M-1)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2013
	Date Received in OIRA: 09/06/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	02/29/2016	02/29/2016
Responses	484	0	484
Time Burden (Hours)	130	0	130
Cost Burden (Dollars)	91,996	0	91,996

---

Abstract: The Health Insurance Portability and Accountability Act of 1996 (HIPAA), codified as Part 7 of Title I of the Employee Retirement Security Act of 1974 (ERISA), was enacted to improve the portability and continuity of health care coverage for participants and beneficiaries of group health plans. To insure compliance with Part 7, section 101(g) of ERISA, HIPAA permits the Secretary of Labor (the Secretary) to require multiple employer welfare arrangements (MEWAs), as defined in section 3(40) of ERISA, to report to the Secretary in such form and manner as the Secretary might determine. The Department of Labor (the Department) published a final rule providing for such reporting on an annual basis, together with a form (Form M-1) to be used by MEWAs for the annual report. See 29 CFR 2520.101-2. Pursuant to section 101(g) of ERISA, the Form M-1 information is used by governmental oversight entities to determine the extent of compliance with the requirements of Part 7 of ERISA by MEWAs and ECEs under section 3(40) of ERISA and to take appropriate compliance assistance and enforcement actions. The Affordable Care Act (ACA) was enacted on March 23, 2010; the Health Care and Education Reconciliation Act (the Reconciliation Act), Public Law 111-152, 124 Stat. 1029, was enacted on March 30, 2010. The ACA amended section 101(g) of ERISA to require MEWAs that provide benefits consisting of medical care (within the meaning of ERISA section 733(a)(2)) which are not group health plans to register with the Secretary before operating in a State, in addition to reporting annually regarding their compliance with part 7 of ERISA. The final regulations implement the ERISA section 101(g) MEWA registration mandate. Thus, paragraph (a) of the final rule sets forth how section 101(g) of ERISA requires MEWAs that provide benefits consisting of medical care (within the meaning of section 733(a)(2) of ERISA) to register with the Secretary prior to operating in a State, and to report annually regarding compliance with part 7 of ERISA.

---

Authorizing Statute(s): US Code: 29 USC 1021(g) Name of Law: Employee Retirement Income Security Act of 1974 (ERISA)
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 6606 Name of Law: Affordable Care Act

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB51	Final or interim final rulemaking	78 FR 13781	03/01/2013

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Form M-1	Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs)

---

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	484	484	0	0	0	0
Annual Time Burden (Hours)	130	130	0	0	0	0
Annual Cost Burden (Dollars)	91,996	91,996	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:

---

Annual Cost to Federal Government: $7,200

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]? Yes

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: 09/06/2013

---