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Group Health Plans Internal Claims and Appeals and External Review Processes
Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans
OMB: 1210-0144
IC ID: 193842
OMB.report
DOL/EBSA
OMB 1210-0144
ICR 202202-1210-006
IC 193842
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Group Health Plans Internal Claims and Appeals and External Review Processes
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 2560.503-1
29 CFR 2590.715-2719
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,007,298
Number of Respondents for Small Entity:
1,746,349
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
58 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
314,560
0
0
159,395
0
155,165
Annual IC Time Burden (Hours)
14,432
0
0
14,083
0
349
Annual IC Cost Burden (Dollars)
571,599
0
0
-178,938
0
750,537
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.