Agency Head Emergency Request

August xx, 2014

MEMORANDUM FOR: Brenda Aguilar

Office of Management and Budget OIRA

THROUGH: Michel Smyth

Departmental Clearance Officer

FROM: PHYLLIS C. BORZI

Assistant Secretary

Employee Benefits Security Administration

SUBJECT: Request for Emergency PRA Clearance

On July 2, 2013, the Department of Health and Human Service, Department of Treasury (Internal Revenue Service), and the Department of Labor published final rules that establish accommodations for contraceptive coverage for health coverage established or maintained by eligible organizations with religious objections to contraceptive services. The final rules require each eligible organization to self-certify that it meets the definition of an eligible organization.

The final rules provide that EBSA Form 700 is used by eligible organizations for their self-certification. The self-certification must be executed by an authorized representative of the organization. It is not submitted to the Department; however, the eligible organization must maintain the self-certification in its records for each plan year to which the accommodation applies and provide a copy of its self-certification to the plan’s health insurance issuer (for insured plans) or third party administrator (for self-insured plans). The EBSA Form 700 is a collection of information subject to the Paperwork Reduction Act (OMB Control Number 1210-0150), which currently is scheduled to expire on August 31, 2016.

On July 3, 2014, the Supreme Court of the United States issued an interim order in connection with an application for an injunction in the pending case of Wheaton College v. Burwell (the “Wheaton order”). The Court ruled that that Wheaton College need not use EBSA Form 700 or send a copy of the executed form to its health insurance issuers or third party administrators to meet the condition for the injunctive relief if it informs the Secretary of Health and Human Services in writing that it is a non-profit organization that holds itself out as religious and has religious objections to providing coverage for contraceptive services.

Currently, the Departments are drafting interim final regulations that will continue to allow eligible organizations to notify an issuer or third party administrator using EBSA Form 700. In addition, the interim final regulations permit an alternative process consistent with the Wheaton order under which an eligible organization would notify the Secretary of HHS that they it will not act as the plan administrator or claims administrator with respect to, or contribute to the funding of, coverage of all or a subset of contraceptive services. Therefore, the interim final regulations will revise the EBSA Form 700 information collection request (ICR).

In order to implement the Supreme Court's order and make an alternative process for eligible organizations available on a timely basis, regulations must be published as soon as possible. The use of normal Paperwork Reduction Act clearance procedures would delay implementation of the Wheaton order and the ability of eligible organizations to avail themselves of the alternative process. Therefore, in accordance with 5 CFR 1320.13, the Department is hereby requesting emergency clearance from OMB for the revision to the EBSA Form 700 ICR within seven (7) days after the Department submits the revised information collection request to OMB.

Thank you for your consideration of this request.

- 2 -