Glossary

Summary of Benefits and Coverage and Uniform Glossary Required Under the Affordable Care Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0147 can be found here:

Documents and Forms

Document Name Document Type
UG April 2017.doc Uniform Glossary-April 2016 IC Document
SBCUniformGlossary - 2012.pdf Uniform Glossary- 2012 IC Document

Information Collection (IC) Details

IC Title:	Glossary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.715-2715

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,299,198	Number of Respondents for Small Entity: 2,158,601

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,250,200	148,201	1,101,999
Annual IC Time Burden (Hours)	10,418	1,235	9,183
Annual IC Cost Burden (Dollars)	431,319	51,129	380,190

Documents for IC

Title	Document	Date Uploaded
Uniform Glossary-April 2016	UG April 2017.doc	04/04/2016
Uniform Glossary- 2012	SBCUniformGlossary - 2012.pdf	04/04/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.