Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act

Forms and Documents

Document Name	Status
1210-0053ss10-5-2015.docx Supporting Statement A	2015-10-07

IC Document Collections

IC ID	Document Title	Status
13352	Employee Benefit Plan Claims Procedure Under ERISA	Modified

ICR Details

OMB Control No: 1210-0053	ICR Reference No: 201510-1210-005
Status: Historical Inactive	Previous ICR Reference No: 201304-1210-006
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 03/04/2016
	Date Received in OIRA: 11/18/2015
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	36 Months From Approved	11/30/2016
Responses	333,612,550	0	333,612,550
Time Burden (Hours)	523,000	0	523,000
Cost Burden (Dollars)	568,700,000	0	568,700,000

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Abstract: ERISA Section 503 and regulations at 29 CFR 2560.503-1 require employee benefit plans to establish procedures for resolving benefit claims under the plan, including initial claims and appeal of denied claims. The regulation requires specific information to be disclosed at different stages of the claims process. It also requires claims denial notices to be provided within specific time frames and to include specific information. These proposed regulations extend protections which were part of the Affordable Care Act to disability plans.

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Authorizing Statute(s): US Code: 29 USC 1133 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB39	Proposed rulemaking	80 FR 72014	11/18/2015

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 70828	11/27/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 31580	05/24/2013
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Employee Benefit Plan Claims Procedure Under ERISA

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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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: As discussed in Item 1, above, with the implementation of the Affordable Care Act, claims regulations participants of disability plans were receiving fewer procedural protections than participants in group health plans, while at the same time experiencing similar if not significantly more issues with the claims review process. These proposed regulations would reduce the inconsistent claims processes applied to health and disability plans and provide similar procedural protections to both groups of plan participants.

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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

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Common Form ICR:  No

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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: 11/18/2015

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