Registration of Group Health Plans and Health Insurance Issuers

No Surprises Act: IDR Process

Documents and Forms

Document Name Document Type
Health Plan Registry Instrument 10.23.23_clean.docx Other-Health Plan Registry Instrumen
Health Plan Registry Instrument 10.23.23_clean.docx Other-Health Plan Registry Instrumen

Information Collection (IC) Details

IC Title:	Registration of Group Health Plans and Health Insurance Issuers	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Health Plan Registry Instrument			Health Plan Registry Instrument 10.23.23_clean.docx		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 426	Number of Respondents for Small Entity: 375

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

Percentage of Respondents Reporting Electronically: 95 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	426	426
Annual IC Time Burden (Hours)	2,025	2,025
Annual IC Cost Burden (Dollars)	0	0

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.